Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction

Luis G Alcalá-González, Carolina Malagelada, Hugo Monrroy, Marianela Mego, Anna Accarino, Juan-Ramon Malagelada, Fernando Azpiroz

Research output: Contribution to journalArticleResearch

Abstract

INTRODUCTION: 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.

METHODS: Retrospective study of patients with chronic digestive symptoms evaluated by intestinal manometry at our center between 2010 and 2018.

RESULTS: 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.

CONCLUSION AND INFERENCE: 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.

Original languageEnglish
Article numbere14462
Pages (from-to)e14462
JournalNeurogastroenterology and Motility
Volume35
Issue number1
Early online date14 Sep 2022
DOIs
Publication statusPublished - Jan 2023

Keywords

  • clustered contractions
  • constipation
  • intestinal manometry
  • intestinal neuropathy
  • minute rhythm
  • small bowel motility

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