Abstract
Despite its size and physiological importance, the human colon is one of the least understood organs of the body. Many disorders arise from suspected abnormalities in colonic contractions, yet, due largely to technical constraints, investigation of human colonic motor function still remains relatively primitive. Most measures of colonic motility focus upon the transit speed (radiology, scintigraphy and, more recently, “smart pills”); however, only colonic manometry can measure pressure/force from multiple regions within the colon in real time (Dinning and Scott (Curr Opin Pharmacol 11:624–629, 2011)). Based upon data from colonic manometry studies, a number of different colonic motor patterns have been distinguished: (1) antegrade high amplitude propagating sequences (contractions), (2) low amplitude propagating sequences, (3) non-propagating contractions, and (4) and rarely episodes of retrograde (oral) propagating pressure waves (Dining and Di Lorenzo (Best Pract Res Clin Gastrolenterol 25(1): 89–101, 2011)). Abnormalities in the characteristics of these motor patterns should help to characterize dysmotility in a patient populations, and in both adults and children colonic motor abnormalities have been identified with manometry studies (Rao et al. Am J Gastroenterol 99(12):2405–2416, (2004), Di Lorenzo et al. Gut. 34(1): 803–807, (1993)). Yet, despite more than two decades of such studies, the clinical utility of colonic manometry remains marginal with no specific manometric biomarkers of colonic dysfunction being established ([Camilleri et al. Neurogastroenterol Motil. 20(12): 1269–1282, 2008). This has been highlighted recently in a colonic manometry study by Singh et al. (2013), in which 41 % of 80 patients, with confirmed slow transit constipation, were reported to have normal motility. While this may suggest that no motor abnormalities exist in a proportion of such patients, the finding may also reflect technical constraints in our ability to detail colonic motility patterns.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Dinning PG, Scott SM. Novel diagnostics and therapy of colonic motor disorders. Curr Opin Pharmacol. 2011;11:624–9.
Dinning PG, Di Lorenzo C. Colonic dysmotility in constipation. Best Pract Res Clin Gastrolenterol. 2011;25(1):89–101.
Rao SS, Sadeghi P, Beaty J, Kavlock R. Ambulatory 24-hour colonic manometry in slow-transit constipation. Am J Gastroenterol. 2004;99(12):2405–16.
Di Lorenzo C, Flores AF, Reddy SN, Snape WJ, Bazzochi G, Hyman PE. Colonic manometry in children with chronic intestinal pseudo-obstruction. Gut. 1993;34(1):803–7.
Camilleri M, Bharucha AE, di Lorenzo C, Hasler WL, Prather CM, Rao SS, et al. American Neurogastroenterology and Motility Society consensus statement on intraluminal measurement of gastrointestinal and colonic motility in clinical practice. Neurogastroenterol Motil. 2008;20(12):1269–82.
Singh S, Heady S, Coss-Adame E, Rao SS. Clinical utility of colonic manometry in slow transit constipation. Neurgastroenterol Motil. 2013; In Press.
Dinning PG, Zarate N, Hunt LM, Fuentealba SE, Mohammed SD, Szczesniak MM, et al. Pancolonic spatiotemporal mapping reveals regional deficiencies in, and disorganization of colonic propagating pressure waves in severe constipation. Neurgastroenterol Motil. 2010;22:e340–9.
• Arkwright JW, Blenman NG, Underhill ID, Maunder SA, Szczesniak MM, Dinning PG, et al. In-vivo demonstration of a high resolution optical fiber manometry catheter for diagnosis of gastrointestinal motility disorders. Opt Express. 2009;17:4500–8. This paper demonstrates the technical advance that fibre optic catheter technology represents.
Arkwright JW, Underhill ID, Maunder SA, Blenman NG, Szczesniak MM, Wiklendt L, et al. Design of a high-sensor count fibre optic manometry catheter for in-vivo colonic diagnostics. Opt Express. 2009;17(25):22423–31.
• Dinning PG, Wiklendt L, Patton V, Bampton PA, Cook I, Gibbons I, et al. Spatial aliasing of colonic manometry data: What have we been missing or mislabeling? Gastroenterology. 2013; In Press (Abstract DDW). This paper demonstrates that with decreasing spacing between recording points colonic motor activity increases, increasing retrograde activity is seen.
•• Giorgio V, Borrelli O, Smith VV, Rampling D, Koglmeier J, Shah N, et al. High-resolution colonic manometry accurately predicts colonic neuromuscular pathological phenotype in pediatric slow transit constipation. Neurogastroenterol Motil. 2013;25(1):70–e9. Demonstrates that neuropathic slow transit constipation correlates with motor activity pattern after bisacodyl. This is the first biomarker described by colonic manometry.
•• Patton V, Arkwright JW, Lubowski DZ, Dinning PG. Sacral nerve stimulation alters distal colonic motility in patients with faecal incontinence. Br J Surg. 2013; In Press. Demonstrates that sacral nerve stimulation in patients with incontinence is associated with and increase rate of retrograde activity. This support the concept of the function of colonic motor activity in the sigmoid colon is in part as a brake to retard content entering rectum.
Dinning PG, Hunt L, Arkwright JW, Patton V, Szczesniak MM, Wiklendt L, et al. Pancolonic motor response to subsensory and suprasensory sacral nerve stimulation in patients with slow-transit constipation. Br J Surg. 2012;99:1002–10.
Grubel C, Hiscock R, Hebbard G. Value of spatiotemporal representation of manometric data. Clin Gastroenterol Hepatol. 2008;6(5):525–30.
George AT, Kalmar K, Panarese A, Dudding TC, Nicholls RJ, Vaizey CJ. Long-term outcomes of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum. 2012;55(3):302–6.
Thomas GP, Dudding TC, Rahbour G, Nicholls RJ, Vaizey CJ. Sacral nerve stimulation for constipation. Br J Surg. 2012; In Press.
Carrington EV, Knowles CH. The influence of sacral nerve stimulation on anorectal dysfunction. Colorectal Dis. 2011;13 Suppl 2:5–9.
Rao SS, Welcher K. Periodic rectal motor activity: the intrinsic colonic gatekeeper? Am J Gastroenterol. 1996;91(5):890–7.
Conflict of Interest
Dr. Philip Dinning has received grant support for his institution from the National Health and Medical Research Council and Medtronic Australia.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Neuromuscular Disorders of the Gastrointestinal Tract
Rights and permissions
About this article
Cite this article
Bampton, P.A., Dinning, P.G. High Resolution Colonic Manometry – What Have We Learnt?- a Review of the Literature 2012. Curr Gastroenterol Rep 15, 328 (2013). https://doi.org/10.1007/s11894-013-0328-2
Published:
DOI: https://doi.org/10.1007/s11894-013-0328-2