Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction
Alcalá-González, Luis Gerardo (Hospital Universitari Vall d'Hebron)
Malagelada Prats, Carolina (Hospital Universitari Vall d'Hebron)
Monrroy, Hugo (Hospital Universitari Vall d'Hebron)
Mego Silva, Marianela (Hospital Universitari Vall d'Hebron)
Accarino, Ana María (Hospital Universitari Vall d'Hebron)
Malagelada Benaprés, Juan Ramón (Hospital Universitari Vall d'Hebron)
Azpiroz Vidaur, Fernando (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	Minute rhythm and prolonged simultaneous contractions are patterns of postprandial small bowel contractile activity that historically have been considered as suggestive of mechanical intestinal obstruction; however, these patterns have been also encountered in patients with motility-like symptoms in the absence of bowel obstruction. The objective of this study was to determine the current diagnostic outcome of patients with these intestinal manometry patterns. Retrospective study of patients with chronic digestive symptoms evaluated by intestinal manometry at our center between 2010 and 2018. The minute rhythm (MRP) or prolonged simultaneous contractions (PSC) postprandial patterns were detected in 61 of 488 patients (55 MRP and 6 PSC). Clinical work-up detected a previously non-diagnosed partial mechanical obstruction of the distal intestine in 10 (16%) and a systemic disorder causing intestinal neuropathy in 32 (53%). In the remaining 19 patients (31%, all with MRP), the origin of the contractile pattern was undetermined, but in 16, substantial fecal retention was detected within 7 days of the manometric procedure by abdominal imaging, and in 6 of them colonic cleansing completely normalized intestinal motility on a second manometry performed within 39 ± 30 days. Currently, the most frequent origin of MRP and PSC encountered on small bowel manometry is intestinal neuropathy, while a previously undetected mechanical obstruction is rare. Still, in a substantial proportion of patients, no underlying disease can be identified, and in them, colonic fecal retention might play a role, because in a subgroup of these patients, manometry normalized after colonic cleansing. Hence, colonic preparation may be considered prior to intestinal manometry. Minute rhythm (or clustered contractions) in postprandial small bowel manometry can be produced by intestinal neuropathy or mechanical occlusion, but in some patients, the minute rhythm pattern is associated with colonic fecal retention, and resolves after colonic cleansing. Hence, colonic preparation may be considered prior to intestinal manometry.
Grants:	Instituto de Salud Carlos III PI17/01794
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Clustered contractions ; Constipation ; Intestinal manometry ; Intestinal neuropathy ; Minute rhythm ; Small bowel motility
Published in:	Neurogastroenterology and Motility, Vol. 35 (september 2022) , ISSN 1365-2982

DOI: 10.1111/nmo.14462
PMID: 36102622

8 p, 1.5 MB

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