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Results for “Myoelectric Complex, Migrating”

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PubMed1994

Antroduodenal manometry in children and adults with severe non-ulcer dyspepsia.

BACKGROUND: Nonulcer dyspepsia is common in adults but has been recognized only recently in children. METHODS: We compared signs, symptoms, and antroduodenal motility findings in 34 children and 35 adults with severe nonulcer dyspepsia. RESULTS: Symptoms and signs were similar in the two groups. Ten children (29%) and one adult (3%) required tube feedings (p = 0.01). Abdominal surgery had been performed on 6 of 34 (18%) children and 18 of 35 adults (51%) (p < 0.01), without relief of symptoms. Esophageal manometry was abnormal in 5 of 23 (22%) children and 6 of 31 (19%) adults. Antroduodenal manometry was suggestive of neuropathy in 25 children and 26 adults and of myopathy in 3 children and 2 adults. Absence of phase 3 of the migrating motor complex was found in 4 children and 17 adults (p = 0.01). Antroduodenal manometry was normal in six children and seven adults. CONCLUSION: Signs, symptoms, and discrete manometric abnormalities of childhood nonulcer dyspepsia resembled those of adult nonulcer dyspepsia. Manometric findings in nonulcer dyspepsia resembled those reported in chronic intestinal pseudo-obstruction, suggesting that these conditions are on a continuum of enteric neuromuscular diseases.

Adolescent↗

PubMed1995

Duodenal secretomotor function in untreated coeliac disease.

BACKGROUND: The aim of the study was to characterize the epithelial transport properties of the distal duodenal mucosa in untreated coeliac disease. METHODS: The study was performed in 20 patients and in 22 healthy controls. Net fluid and bicarbonate transport was measured with a triple-lumen perfusion technique. Interdigestive motility was recorded by manometry, and the transmural potential difference (PD) was measured as an indicator of electrogenic anion secretion. RESULTS: In the patients a net fluid secretion was seen (-1.04 +/- 0.26 versus 0.12 +/- 0.11 ml/min x 10 cm in the controls; p < 0.01), and there was no significant net bicarbonate absorption (5.6 +/- 3.4 versus 27.5 +/- 4.4 mumol/min x 10 cm in the controls; p < 0.001). The epithelial transport rate varied with the interdigestive motility; a shift in the secretory direction was seen in late phase II of the migrating motor complex (MMC). Moreover, the MMC-related PD curve was significantly displaced in the lumen-negative direction (p < 0.001 versus controls). CONCLUSIONS: The results suggest that in untreated coeliac disease, active chloride secretion is enhanced, and Na+/H+ exchange is reduced. This remodelled mucosa still seems to respond to neurogenic stimuli, as suggested by the presence of MMC-related changes in secretion rate.

Adolescent↗

PubMed2002

Enteric nerve stimulation evokes a premature colonic migrating motor complex in mouse.

The effects of enteric nerve stimuli were investigated on spontaneously occurring colonic migrating motor complexes (CMMCs) in isolated mouse colon. Changes in circular smooth muscle tension were recorded simultaneously from the proximal, mid and distal regions of an in vitro preparation of whole mouse colon at 36 +/- 1 degrees C. The CMMCs were recorded from all preparations with a mean interval between contractions ranging from 135.2 +/- 9.3 to 163.3 +/- 22.4 s. The CMMCs migrated spontaneously from the proximal to distal colon and were abolished by tetrodotoxin (1 micromol L-1). In approximately half of all trials (57 of 103, n = 31), trains of stimuli (20 Hz, 2-5 s, 1 ms, 40-70 V) delivered to the mid or distal regions of colon, during the intervals between CMMCs, elicited a premature CMMC. However, similar trains of stimuli delivered to the proximal colon were without similar effects (33 trials, n = 13). It is suggested that in isolated whole mouse colon, CMMCs can be evoked prematurely by trains of electrical stimuli applied to the enteric nerves. The observation that nerve stimuli failed to evoke a premature CMMC from the proximal colon suggests that selective activation of functional ascending pathways may be required to initiate a premature CMMC.

Anesthetics, Local↗

PubMed1992

Roux-limb motility after total gastrectomy and Roux-en-Y anastomosis in patients with Zollinger-Ellison syndrome.

The Roux-en-Y syndrome was defined as chronic nausea, intermittent vomiting, and chronic abdominal pain worsened by eating in patients who have undergone a gastrojejunostomy Roux-en-Y reconstruction for peptic ulcer. When these patients fasted, the Roux limb showed striking abnormalities in motor function; when postprandial, they failed to convert to normal fed-state motor activity. In contrast, patients with Zollinger-Ellison syndrome do well after similar surgery; they can eat most foods and maintain their body weight. We studied the motility of the Roux limb and jejunum in six patients with Zollinger-Ellison after an esophagojejunostomy Roux-en-Y anastomosis. Roux-limb motor activity in these patients, as characterized by the migrating motor complex, was more frequent, well organized, and in synchrony with the remaining jejunum; most subjects also converted to the fed state after a liquid meal. We suggest that the enteric nervous system is intact and functions normally in patients who have had a Roux-en-Y reconstruction for ulcer disease secondary to Zollinger-Ellison, but not in patients with idiopathic peptic ulcer disease.

Adult↗

PubMedDate not supplied

Abnormalities of the interdigestive migrating motor complex in a patient with carcinoid syndrome.

Intraluminal pressures of the gastric antrum, duodenum and jejunum were recorded for 206 min after a 12 h fast in a patient with carcinoid syndrome due to neoplasia of enterochromaffin cells of the ileum and with hepatic metastases. The most conspicuous alteration was a tachyrrhythmia of 16 waves/min predominating in the activity fronts of both duodenum and jejunum. Periods of 11-12 waves/min frequency appeared irregularly and the simultaneous occurrence of frequencies of 11 waves/min and 16 waves/min was also recorded. The gastric antrum was fully quiescent throughout the study. The alterations observed are presumed to be produced by substances secreted by the carcinoid tumor.

Duodenum↗

PubMed2001

5-hydroxytryptamine and the gastrointestinal migrating motor complex.

The migrating motor complex (MMC) is the basic cyclic pattern of gastrointestinal motility that is observed in the interdigestive periods in humans as well as in monogastric animals. Among the mediators involved in its regulation, an increasing number of reports point out that 5-hydroxytryptamine (5-HT) has a pivotal role. Taking into account that this pattern is disturbed in patients suffering from several gastrointestinal disorders, studies leading to a better understanding of 5-HT actions have special relevance. This article reviews the current knowledge on the role of 5-HT receptors in the control of the MMC.

Animals↗

PubMed1997

Pathophysiology of adynamic ileus.

We hypothesized that the inhibitory neurotransmitters nitric oxide (NO) and vasoactive intestinal peptide (VIP) may play a role in the disrupted gastrointestinal motility of endotoxemia. Strain gauge transducers on the stomach and small intestine of dogs determined interdigestive gastrointestinal motility. Tissue levels of NO synthase and VIP and serum levels of nitrite/nitrate (NO(2)-/NO(3)-) and VIP were measured. Following completion of the baseline studies, dogs were given a single dose of E. coli lipopolysaccharide, 200 microg/kg intravenously, and the studies were repeated for the next three days. Following endotoxin bolus, the migrating motor complex (MMC) was delayed for two days while serum VIP was increased on postendotoxin day 1 and serum NO(2)-/NO(3)- was increased on postendotoxin day 2. There were no changes in gut smooth muscle levels of NO synthase or VIP. We conclude that a single, sublethal dose of endotoxin results in prolongation of the MMC with distinct but independent increases in serum levels of VIP and NO(2)-/NO(3)-.

Animals↗

PubMed1995

Role of the vagal branches to the proximal stomach in mediating gastric distention-induced disruption of canine interdigestive upper gut motility.

Previous experiments from our laboratory have shown that the vagus nerves mediate proximal gastric distention-induced disruption of interdigestive motor patterns in the upper gut of dogs. Our aim was to determine the role of vagal innervation of the proximal stomach in mediating the response to nonnutrient proximal gastric distention. Five dogs underwent proximal gastric vagotomy (PGV) and placement of electrodes and manometry catheters on the antrum and the upper small intestine. Proximal gastric distention for 5 hr was achieved by inflating a thin, compliant bag in the proximal stomach. Four volumes of distention stimulus (0, 1.5, 12.5, and 25 ml/kg) were tested. As with total abdominal vagotomy, intragastric stimulus volumes of 12.5 and 25 ml/kg after PGV no longer inhibited cycling of the migrating motor complex in the stomach, duodenum, proximal jejunum, and distal jejunum. Volumes of 12.5 and 25 ml/kg did, however, on occasion, lead to the absence of phase III activity in the stomach or the duodenum when it would have been expected to precede phase III activity in the jejunum; this effect did not occur in the jejunum. These findings with a nonnutrient stimulus suggest that vagal branches to the proximal stomach might mediate, in part, the postprandial changes in upper gut motility in response to gastric distention by ingestion of a meal.

Animals↗

PubMed1991

Inversion of the slow-wave frequency gradient in symptomatic patients with Roux-en-Y anastomoses.

Patients with Roux-en-Y anastomoses may have chronic symptoms of nausea, vomiting, epigastric fullness, and abdominal pain. To investigate the mechanism of these symptoms, the electrical activity of the Roux limb was studied in five symptomatic and four asymptomatic patients with Roux-en-Y anastomoses. Slow-wave and spike activity in the Roux limb were recorded using six bipolar suction electrodes positioned 10 cm apart. Ten healthy volunteers were studied as a control. In the control subjects, the mean slow-wave frequency decreased from 11.27 +/- 0.2 cycles/min at 30 cm below the ligament of Treitz to 10.96 +/- 0.2 cycles/min at 80 cm past Treitz. By contrast, in five patients the slow-wave frequency in the Roux limb increased from 11.12 +/- 0.2 cycles/min 10 cm below the gastrojejunal anastomosis to 11.42 +/- 0.4 cycles/min 50 cm more distally. Four of these five patients had severe symptoms. In the other four patients, of whom three were completely symptom-free, an aborally decreasing slow-wave frequency was observed. In both the controls and the patients with Roux-en-Y anastomoses, the direction of propagation of phase 3 spike bursts of the migrating motor complex was always aboral. During phase 2, most spike bursts were uncoordinated at adjacent recording sites. Propagated spike bursts, single or repetitive, were rare. The propagation direction of these spike bursts was always aboral in healthy controls. In symptomatic patients with inverted slow wave frequency gradients, however, the rare propagated spike bursts always propagated orally. The observed electrical abnormalities may in part be responsible for the symptoms of patients with the Roux-en-Y syndrome.

Abdominal Pain↗

PubMed1992

Somatostatin 28 and coupling of human interdigestive intestinal motility and pancreatic secretion.

To determine the effects of small increases in somatostatin 28 plasma concentrations on human interdigestive gastrointestinal motility and pancreatic secretion, six fasting volunteers were intubated with gastroduodenal multilumen tubes and motility and pancreatic enzyme secretion were measured. Subjects received intravenous NaCl and somatostatin 28 at 11 and 44 pmol.kg-1.h-1 for 120 minutes or at least one interdigestive cycle. The two doses increased plasma somatostatin 28 levels within the physiological or into the supraphysiological range, respectively. Somatostatin 28 at 11 and 44 pmol.kg-1.h-1 decreased the length of the interdigestive motility cycle by 50% and 67% compared with controls, respectively (both P less than 0.002). Propagation velocity of the migrating motor complex (P less than 0.01) and plasma motilin were decreased (P less than 0.01). The smaller and larger dose decreased pancreatic enzyme outputs by 50% and 65%, respectively (P less than 0.005), but with the smaller dose, phase III-associated enzyme outputs were greater than phase I outputs. These findings suggest that small changes in somatostatin 28 plasma concentrations modulate human interdigestive motility and pancreatic enzyme output while coupling of motor and secretory events is preserved.

Adult↗

PubMed1994

Effect of octreotide on gastrointestinal pressure profiles in health and in functional and organic gastrointestinal disorders.

The somatostatin analogue, octreotide, restores normal pressure profiles in disorders of upper gut motility. This study aimed to evaluate the acute effects of octreotide in five healthy subjects and in 50 consecutive patients with functional (n = 22) or organic (n = 28) dysmotility. Antroduodenojejunal manometry was performed during three hours' fasting, for two hours after a standard meal, and 30 minutes after subcutaneous injection of 50 micrograms octreotide. Antral motility, before and after octreotide, and characteristics of spontaneous migrating motor complexes and octreotide induced activity fronts were compared. Octreotide inhibited antral motility and induced a small intestinal activity front followed by motor quiescence in all healthy subjects and patients. The duration and propagation velocity of activity fronts were greater than those of spontaneous migrating motor complexes. Thirty per cent of activity fronts began simultaneously at different levels of small bowel, and in 20%, a second, normally propagated activity front developed within 30 minutes of octreotide injection. Octreotide induces rapidly propagated, long activity fronts, even in patients with neuropathology, and this may initially facilitate the intestinal propulsion of chyme. Propulsion may not occur, however, if octreotide induces simultaneous activity fronts or if the activity front is followed by prolonged quiescence. Inhibition of antral motility suggests that octreotide may not be effective in gastroparesis.

Adolescent↗

PubMed1994

The effect of epidural morphine on human intestinal motility in the early postoperative period.

The early postoperative recovery of intestinal motility and the response of motility to epidural morphine were investigated in 20 patients. Periodic motor activities in the jejunum were recovered within 32 hours in all cases. The length of these cycles increased gradually from the 1st (23.2 min) to the 4th (41.7 min) postoperative day. Morphine and lignocaine were given through an epidural catheter. Morphine induced premature migrating motor complexes (MMC) in all cases, whereas lidocaine failed to evoke this response in every case. The mean duration (19.8 min) and maximal amplitude (62.8 mmHg) of the burst activities induced by morphine were significantly longer and higher than those occurring spontaneously (7.7 min and 35.6 mmHg, respectively). The intervals between the induced and the subsequent spontaneous contractions were the same as the intervals between spontaneous contractions. These observations indicate that epidural morphine induced premature MMC without interrupting recovery patterns from postoperative gastrointestinal paralysis.

Adult↗

PubMed2001

Gastric IgA in cystic fibrosis in relation to the migrating motor complex.

BACKGROUND: Gastrointestinal symptoms in cystic fibrosis are frequent, but little is known about the underlying pathophysiology. Mucosal secretion of IgA is important for the immunologic function in the human gastrointestinal tract but has not been studied in cystic fibrosis. The aim of this study was to quantify the release of IgA by the gastric mucosa in relation to interdigestive motor activity in patients with cystic fibrosis with different genotypes. METHODS: The study included 7 healthy adult volunteers and 10 adult patients with cystic fibrosis, all Helicobacter pylori-negative. All patients had pathological sweat tests and clinical symptoms and signs of cystic fibrosis. All but one were colonized with Pseudomonas aeruginosa. Three patients were pancreatic sufficient. The investigation was performed using intragastric perfusion and gastroduodenal manometry. RESULTS: During the investigation, 8 of 10 patients with cystic fibrosis showed the characteristic pattern of interdigestive motility. The patients had significantly lower levels of gastric IgA compared to healthy subjects during phases II and III of migrating motor complex, median (range) 120 (67-442) and 36 (6-299) microg/5 min. 382 (40-1176) and 56 (4-398) (P = 0.03 and P = 0.04), respectively. Only one patient with genotype R668C/unknown showed IgA levels within the normal range. There was no correlation to gastric presence of duodenogastric reflux markers. CONCLUSION: The interdigestive motility pattern was normal in most patients with cystic fibrosis. The low levels of IgA released from the gastric mucosa in the patients might indicate a defective gastric transmucosal IgA transport in cystic fibrosis.

Adult↗

PubMed1996

Inhibition of nitric oxide synthase in the brain suppresses colonic motor activity.

The effects of inhibition of nitric oxide (NO) synthase in the brain on colonic motor activity were investigated in conscious dogs. Intracerebroventricular (ICV) infusion of N omega-nitro-L-arginine methyl ester (L-NAME) and N omega-nitro-L-arginine (L-NNA) significantly suppressed colonic motor activity. The inhibitory effects occurred 1 h after the end of the infusion and lasted for at least 4 h. This suppression was blocked by a concurrent infusion of L-arginine but not D-arginine. The suppression of colonic motor activity was not blocked by bilateral truncal vagotomy or intravenous administration of phentolamine, an alpha-receptor antagonist, and propranolol, a beta-receptor antagonist. ICV infusion of L-NAME had no significant effect on the occurrence of giant migrating contractions in the colon. By contrast, intravenous administration of L-NAME at higher doses significantly enhanced colonic motor activity. We conclude that the inhibition of NO synthesis in the brain suppresses, whereas the inhibition of NO synthesis in peripheral neurons stimulates, colonic motor activity. The central effect may be mediated by a decrease in cerebral blood flow due to the inhibition of NO synthesis in cerebral arteries.

Animals↗

PubMed1994

Determinants of response to a prokinetic agent in neuropathic chronic intestinal motility disorder.

BACKGROUND/AIMS: Reasons for the variable efficacy of prokinetic agents in the treatment of chronic intestinal motility disorders are unclear. The aim of this study was to assess the influence of extrinsic autonomic neuropathy and motility patterns on the symptom response to cisapride in 42 such patients. METHODS: A randomized, double-blind, placebo-controlled, two-dose (10 and 20 mg, three times daily), 12-week study included (1) measurement of autonomic (including abdominal vagal) function; (2) standardized 5-hour upper gastrointestinal manometry; and (3) assessment of symptoms based on visual analog scale at baseline and 6 and 12 weeks. Statistical analysis compared symptom response among treatment and autonomic dysfunction groups and assessed the influence of absence of migrating motor complexes and presence of postprandial antral hypomotility on symptomatic responses to cisapride. RESULTS: There was no significant overall effect of cisapride in the entire group of 42 patients. Generalized sympathetic and vagal dysfunctions influence the response of patients with neuropathic chronic intestinal motility disorder to two doses of cisapride. CONCLUSIONS: Idiopathic intestinal motility disorder, unassociated with abdominal vagal dysfunction, is more likely to respond to cisapride. Detailed characterization of patient subgroups is crucial to designing treatment trials in patients with small bowel motility disorders.

Adult↗

PubMed1990

Interdigestive cycling and post-prandial release of pancreatic polypeptide in severe obesity.

Changes in pancreatic polypeptide plasma concentrations have been reported in obesity. It has been suggested that altered PP plasma levels may play a role in the abnormal food intake observed in obesity. Earlier studies, however, have not considered the physiological fluctuations of PP during fasting. We examined PP plasma concentrations in 12 subjects with severe obesity and in 10 normal subjects during the entire cycle of interdigestive motility and after the administration of a standard mixed meal. Obese patients and healthy controls showed similar fluctuations of PP during individual phases of the migrating motor complex (MMC) and reached their peak PP plasma levels (134 +/- 35 (s.e.m.) pg/ml in controls vs 113 +/- 17 pg/ml in obese subjects) during phase III activity. Following the test meal, prompt release of PP occurred which was significantly higher than basal values at each 15 min interval during the first postprandial hour in both controls and obese patients. The integrated PP postprandial response at 60 min did not differ between obese patients (163 +/- 15 pg/ml.h) and controls (198 +/- 37 pg/ml.h; n.s.). A putative causal role for PP in obesity thus seems very unlikely.

Adult↗

PubMed1992

Does irradiation produce irreversible changes in canine jejunal myoelectric activity?

We sought to determine whether acute irradiation-induced changes in jejunal myoelectric activity are reversible or chronic and progressive with repeated exposures. Five dogs underwent abdominal irradiation absorbing 938 cGy on four separate occasions, two weeks apart. Recordings of jejunal myoelectric activity were made before and 10-11 days after each irradiation exposure. Ten to 11 days after the first exposure, the animals recovered completely from the acute radiation syndrome, and the myoelectric activity returned to normal. After subsequent exposures, they developed chronic diarrhea, profound weight loss, and progressive changes in myoelectric activity. Slow waves exhibited highly variable configuration, had an irregular rhythm, and were frequently uncoupled. Spike burst activity, duration, and length of migration were reduced in association with abnormal motility patterns even though histologic abnormalities were mild. Such changes are likely to interfere with normal propulsion and contribute to impaired nutrition. The abnormalities suggest that irradiation causes dysfunction of one or more of the cellular elements involved in small bowel motility (muscle, nerve, and interstitial cells) prior to the development of severe histologic abnormalities or mechanical obstruction.

Action Potentials↗

PubMed1990

The relationship between interdigestive gallbladder and gastroduodenal motility in man.

The relationship between interdigestive gallbladder and gastroduodenal motility simultaneously with the behavior of plasma motilin and CCK levels in 20 subjects was investigated. We used an infusion catheter method for the measurement of gastroduodenal motility, and real-time ultrasonography for the measurement of gallbladder size. In gastric phase II, the gallbladder contracted with extension of the major axis and shrinking of the minor axis, with its minimum volume being 84% of the volume in phase I. The gallbladder then filled rapidly assuming a sphere-like shape with extension of the minor axis and shrinking of the major axis in gastric phase I. This motility was recognized only during the gastrointestinal interdigestive migrating complex (GI-IMC) cycle, originating in the stomach, and was associated with an increase of motilin levels, it was not seen before or after the intestinal IMC (I-IMC), which originated in the duodenum without contraction of the stomach or an increase of motilin levels. Furthermore no apparent relationship was recognized between CCK and gastric or gallbladder motility. Our findings suggest that gallbladder motility in the interdigestive period has a close relationship with gastroduodenal motility and is related to the appearance of the GI-IMC.

Adult↗