Spatial and temporal patterns of human jejunal contractions.

We recorded human jejunal motor activity by a 12-lumen manometric tube with recording sites 2 cm apart. The contractile activity in the fasted and the fed state was analyzed by computer to define the spatial and temporal patterns of contractions. Mean duration and area of single contractions during phase III activity were not different from those during phase II activity. By contrast, the frequency and amplitude of contractions, their propagation distance, and the percentage of contractions that propagated for greater than or equal to 2 cm were significantly greater during phase III than during phase II activity. The mean frequency and percentage of propagated contractions in the fed state were intermediate between those during phase II and phase III activity. Mean propagation distance of postprandial contractions was not different from that of phase II contractions. Most contractions in the fed state were uncoordinated at adjacent recording sites. Occasionally, large-amplitude and long-duration contractions, called individual migrating contractions, propagated over long distances and frequently over the entire 22-cm study segment. We conclude that there are some significant differences between the spatial and temporal patterns of contractions between the fed state and phase II and phase III activity. The largely disorganized phasic contractions in the fed state may cause mostly mixing of the ingested meal and its slow distal propagation, whereas the infrequent individual migrating contractions may rapidly propel intestinal contents over longer distances.

Treatment of acute nontoxic megacolon during colonoscopy: tube placement versus simple decompression.

The study compares the efficacy of colonoscopic decompression versus decompression and tube placement in the treatment of Ogilvie's syndrome. Nine patients were treated with a single colonoscopic decompression which resulted in four recurrences. In contrast, there were no recurrences observed in 11 patients who underwent decompression and subsequent tube placement (p less than 0.05). There was no morbidity observed from either decompression or tube placement. Tube placement added less than 10 min of additional procedure time to the colonoscopy. The tube utilized in this study was an enteroclysis tube with sideholes cut in the distal 20 cm. The tube was easily inserted over a Teflon-coated flexible guide wire inserted through the colonoscope into the cecum following decompression. This study demonstrates that colonoscopic decompression followed by tube placement is the preferred treatment modality for acute nontoxic megacolon.

Multipeaked esophageal peristaltic pressure waves in patients with diabetic neuropathy.

We evaluated esophageal function in 14 consecutive insulin-dependent diabetic patients who had evidence of peripheral and autonomic neuropathy, but no esophageal symptoms. One to three contraction waves immediately followed a primary peristaltic contraction wave. The majority of these multipeaked pressure complexes consisted of two peaks. Multipeaked contractions were observed with all peristaltic waves in 12 of the 14 diabetic patients and with most of the peristaltic complexes in the remaining 2 patients. Multipeaked peristaltic waves were present in 1 of 6 diabetic patients without neuropathy, in 1 of 100 consecutive nondiabetic patients referred for suspected esophageal disease, and in 1 of 10 healthy volunteers. Double-peaked peristaltic pressure complexes in the nondiabetic control subjects differed from those present in the insulin-dependent patients by their low incidence and by a tendency to be limited to the distal esophagus. Pharmacologic responses to edrophonium and atropine suggested a possible increased cholinergic tone as the basis of the multipeaked peristaltic waves in diabetics with autonomic neuropathy.

Gastric emptying in patients with diabetes mellitus.

We evaluated whether chronic nausea and vomiting in diabetic patients correlate with abnormal gastric emptying of liquid or solid, or both liquid and solid, radiolabeled meals and recorded the acute effects of metoclopramide. last, we compared several methods of analyzing gastric emptying data obtained using the gamma-camera. Eighteen healthy control subjects and 16 insulin-dependent diabetics with neuropathy were investigated. Ten of the patients suffered from chronic nausea and vomiting; the remaining 6 served as disease controls. Gastric emptying of solid and liquid meals could best be described by the slopes of two linear components and their intercept. Liquid meals generally were handled normally, while solid meals were emptied slowly by both groups of diabetics. A single dose of metoclopramide frequently corrected the delayed onset of the second, more rapidly emptying phase, that is, the major abnormality of solid emptying. The radiologic findings during a barium meal did not distinguish symptomatic from asymptomatic patients. We conclude that abnormal gastric motor function, manifested by delayed emptying of a solid meal or barium suspension, or both, is common in diabetics with neuropathy and that this motor abnormality is not the only cause of chronic vomiting. The beneficial, often short-term symptomatic effects of metoclopramide in these patients appear to be mediated by a combination of normalization of gastric emptying and a central antiemetic action.