Effect of colonic distension on small bowel motility measured by jejunal high-resolution manometry

Colonic distension; High-resolution manometry; Small bowel motilityDistensió colònica; Manometria d'alta resolució; Motilitat de l'intestí primDistensión colónica; Manometría de alta resolución; Motilidad del intestino delgadoBackground Abnormal motility patterns in the jejunum can be detected in patients with prominent colonic content, and these abnormalities may be due to either a primary jejunal dysfunction or a reflex distortion. The objective of the present study was to determine the effect of colonic distension on small bowel postprandial motility using high-resolution manometry. Methods Single center, controlled, parallel, randomized, single blind study in healthy subjects testing the effect of colonic filling vs sham infusion on the responses to a meal in 16 healthy subjects. Nutrients were continuously infused in the proximal jejunum (2 Kcal/min) during the 2-h study period to induce a steady-state postprandial motor pattern. Jejunal motility was measured by water-perfused, high-resolution manometry. After 1 h postprandial recording (basal period), gas was infused during 7.5 min via a rectal tube (720 mL or sham infusion), and jejunal motility was recorded for another hour. Key Results Jejunal postprandial motility during the basal period was characterized by two overlapping components: a) continuous segmental activity (non-propagated or shortly propagated) and b) intercurrent propagated fronts (3.8 ± 1.1 fronts of 2-5 clustered contractions/h >10 cm propagation). As compared to sham infusion, colonic gas filling: a) inhibited continuous segmental contractile activity (by 17 ± 4%; p = 0.044 vs control group) and b) stimulated intermittent propagated fronts (up to 9.0 ± 2.2 fronts/h; p = 0.017 vs control group). Conclusions and Inferences Long retrograde reflexes induced by colonic distension distort the balance between segmental and propagated activity, and may affect the normal response of the jejunum to food ingestion. Jejunal manometry in patients may be artifacted by colonic overload

Evaluation of abdominal gas by plain abdominal radiographs

Abdominal CT imaging; Abdominal distension; Intestinal gasTAC abdominal; Distensión abdominal; Gas intestinalTAC abdominal; Distensió abdominal; Gas intestinalBackground Our aim was to determine the reliability of plain abdominal radiographs for the evaluation of abdominal gas content in patients with functional digestive symptoms. Methods Abdominal CT scan scout views, mimicking a conventional plain abdominal radiograph, were obtained from 30 patients both during episodes of abdominal distension and basal conditions. Physicians (n = 50) were instructed to rate the estimated volume of gas in the 60 images presented in random sequence using a scale graded from 0 to ≥600 ml. Key Results The gas volumes estimated in the scout views differed from those measured by CT by a median of 90 (95% CI 70–102) ml, and the misestimation was not related to the absolute volume in the image. The accuracy of the observers, measured by their mean misestimation, was not related to their specialty or the training status (misestimation by 96 (95% CI 85–104) ml in staff vs 78 (70–106) ml in residents; p = 0.297). The accuracy was independent of the order of presentation of the images. Gas volume measured by CT in the images obtained during episodes of abdominal distension differed by a median of 39 (95% CI 29–66) ml from those during basal conditions, and this difference was misestimated by a median of 107 (95% CI 94–119) ml. The accuracy of these estimations was not related to the absolute gas volumes (R = −0.352; p < 0.001) or the magnitude of the differences. Conclusions & Inferences Plain abdominal radiographs have limited value for the evaluation of abdominal gas volume in patients with functional gut disorders.This work was supported in part by the Spanish Ministry of Economy and Competitiveness (Dirección General de Investigación Científica y Técnica, grant SAF 2016-76,648-R to F Azpiroz); Ciberehd is funded by the Instituto de Salud Carlos III. Dan M. Livovsky received support from the Israeli Medical Association and from Israeli Gastroenterological Association 2020 fellowship grants

Abdominothoracic Postural Tone Influences the Sensations Induced by Meal Ingestion

Distensió abdominal; Ingestió de menjars; Respostes postprandialsDistensión abdominal; Ingestión de comida; Respuestas posprandialesAbdominal distension; Meal ingestion; Postprandial responsesPostprandial objective abdominal distention is frequently associated with a subjective sensation of abdominal bloating, but the relation between both complaints is unknown. While the bloating sensation has a visceral origin, abdominal distention is a behavioral somatic response, involving contraction and descent of the diaphragm with protrusion of the anterior abdominal wall. Our aim was to determine whether abdominal distention influences digestive sensations. In 16 healthy women we investigated the effect of intentional abdominal distention on experimentally induced bloating sensation (by a meal overload). Participants were first taught to produce diaphragmatic contraction and visible abdominal distention. After a meal overload, sensations of bloating (0 to 10) and digestive well-being (−5 to + 5) were measured during 30-s. maneuvers alternating diaphragmatic contraction and diaphragmatic relaxation. Compared to diaphragmatic relaxation, diaphragmatic contraction was associated with diaphragmatic descent (by 21 + 3 mm; p < 0.001), objective abdominal distension (32 + 5 mm girth increase; p = 0.001), more intense sensation of bloating (7.3 + 0.4 vs. 8.0 + 0.4 score; p = 0.010) and lower digestive well-being (−0.9 + 0.5 vs. −1.9 + 0.5 score; p = 0.028). These results indicate that somatic postural tone underlying abdominal distention worsens the perception of visceral sensations (ClinicalTrials.gov ID: NCT04691882).This work was supported in part by the Spanish Ministry of Economy and Competitiveness (Dirección General de Investigación Científica y Técnica, SAF 2016-76648-R). Ciberehd is funded by the Instituto de Salud Carlos III. Dan M. Livovsky received support from the Israeli Medical Association and from Israel Gastroenterological Association 2020 fellowship grants