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Colonic Motility and Symptoms in Patients with the Irritable- Triner, L., Vulliemoz, Y., Schwartz, I., and Nahas, G Gut: first published as 10.1136/gut.16.4.311 on 1 April 1975. Downloaded from Symposium on colonic function 311 Fishlock, D. J., and Parks, A. G. (1963). A study of human colonic Misiewicz, J. J., Waller, S. L., and Eisner, M. (1966). Motor responses muscle in vitro. Brit. med. J., 2, 666-667. of the human gastrointestinal tract to 5-hydroxytryptamine in Fishlock, D. J., Parks, A. G., and Dewell, J. V. (1965). Action of vivo and in vitro. Gut, 7, 208-216. 5-hydroxytryptamine on the human stomach, duodenum and Neely, J., and Catchpole, B. (1971). Ileus: the restoration ofalimentary- jejunum in vitro. Gut, 6, 338-342. tract motility by pharmacological means. Brit. J. Surg., 58, Fishlock, D. J. (1966). Effect of bradykinin on the human isolated 21-28. small and large intestine. Nature (Lond.), 212, 1533-1535. Painter, N. S., and Truelove, S. C. (1964a). The intraluminal pressure Fleshler, B., and Bennett, A. (1969). Responses of human, guinea-pig, patterns in diverticulosis of the colon. Parts I and II. Gut, 5, and rat colonic circular muscle to prostaglandins. (Abstr.) J. 201-213. Lab. clin. Med., 75, 872-873. Painter, N. S., and Truelove, S. C. (1964b). The intraluminal pressure Furness, J. B., and Costa, M. (1973). The nervous release and the action patterns in diverticulosis of the colon. Parts III and IV. Gut, of substances which affect intestinal muscle through neither 5, 365-373. adrenoceptors nor cholinoreceptors. Phil. Trans. roy. Soc. Pertsiounis, S. (1970). In: Lactulose in the treatment of portal systemic Lond. B., 265, 123-133. encephalopathy. Gastroenterology, 58, 595-597. Gagnon, D. J., Devroede, G., and Belisle, S. (1972). Excitatory effects Phillips, R. A., Love, A. H. G., Mitchell, T. G., and Neptune, E. M., of adrenaline upon isolated preparations of human colon. Gut, Jr. (1965). Cathartics and the sodium pump. Nature (Lond.), 13, 654-657. 206, 1367-1368. Garrett, J. R., Howard, E. R., and Nixon, H. H. (1969). Autonomic Rousseau, B., and Sladen, G. E. (1970). Effect of luminal pH on nerves in rectum and colon in Hirschsprung's disease. Arch. intestinal absorption of water and electrolytes. Gut, 11, 1056. Dis. Child., 44, 406-417. Sandler, M., Karim, S. M. M., and Williams, E. D. (1968). Prosta- Hardcastle, J. D., and Mann, C. V. (1968). Study of large bowel glandins in amine-peptide-secreting tumours. Lancet, 2, 1053- peristalsis. Gut, 9, 512-520. 1054. Hart, S. L., and McColl, I. (1968). The effect of the laxative oxyphen- Stockley, H. L., and Bennett, A. (1974). The intrinsic innervation of isatin on the intestinal absorption of glucose in rat and man. human sigmoid colonic muscle. In Proceedings of the fourth Brit. J. Pharmacol., 32, 683-686. International Symposium on Gastrointestinal Motility, edited by Harvey, R. F., and Read, A. E. (1973). Effect of cholecystokinin on E. E. Daniel, Mitchell, Vancouver. pp. 163-176. colonic motility and symptoms in patients with the irritable- Triner, L., Vulliemoz, Y., Schwartz, I., and Nahas, G. G. (1970). bowel syndrome. Lancet, 1, 1-3. Cyclic phosphodietserase activity and the action ofpapaverine. Lindner, A., Selzer, H., Claassen, V., Gans, P., Offringa, 0. R., and Biochem. Biophys. Res. Commun., 40, 64-69. Zwagemakers, J. M. A. (1963). Pharmacological properties Vane, J. R. (1971). Inhibition of prostaglandin synthesis as a mechan- ofmebeverine, a smooth-muscle relaxant. Arch. intern. Pharma- ism of action for aspirin-like drugs. Nature [new Biol.], 231, codyn., 145, 378-395. 232-235. Misiewicz, J. J., Holdstock, D. J., and Waller, S. L. (1967). Motor Vaughan-Williams, E. M. (1954). The mode of action of drugs upon responses of the human alimentary tract to near-maximal intestinal motility. Pharmacol. Rev., 6, 159-190. infusions of pentagastrin. Gut, 8, 463-469. http://gut.bmj.com/ Colonic motility J. J. MISIEWICZ From the Medical Research Council Gastroenterology Unit, Central Middlesex Hospital, London, on September 23, 2021 by guest. Protected copyright. and St Mark's Hospital, London Colonic motoractivitymaybedivided into twomodes: cal or physiological stimuli. Nor is it certain how propulsive contractions or mass movements and either type of activity is altered in disease. The inter- non-propulsive contractions or segmental activity. play of the effects of the various biogenic substances Although it seems that the two modes of activity and the relationship between absorptive (see appear to have different functions, are effected by Cummings, this symposium) and the motor func- different types of muscle contraction, and may be tions of the large bowel, remain to be worked out. mediated through separate pathways, the division should be regarded as convenient for descriptive Mass Movements purposes, rather than resting on sound experimental foundations. Despite considerable progress in Colonic mass movements are difficult to record, and electrophysiology and pharmacology of the colon have not been extensively studied. They were (see reviews by Daniel and Bennett, this symposium), initially observed radiologically, but the now known the regulation of human colonic motor function in hazards of ionizing radiation limit radiological health and disease is still not well understood. It is observation, even with sophisticated time-lapse not known precisely how either mode of colonic cinefluorography (Ritchie, Ardran, and Truelove, contraction is initiated, although both mass move- 1962). Some information on the distribution of ments and segmental contractions can be experimen- faeces before and after a mass movement can be tally stimulated or inhibited by many pharmacologi- collected by using radioopaque markers (Hinton, Gut: first published as 10.1136/gut.16.4.311 on 1 April 1975. Downloaded from 312 J. J. Misiewicz Lennard-Jones, and Young, 1969) and judiciously The recorded pressure waves appear to be similar spaced plain abdominal films: the surprisingly in amplitude and duration over the whole colon, localized extent of colonic evacuation after defaeca- with the exception of the caecum and the rectum tion and the existence of retropulsion have been (Misiewicz et al, 1966; Kock, Hulten, and Leander, documented in this way (Halls, 1965). 1968). In the colon, the amplitude lies commonly Specialized techniques employing detailed moni- between 10 and 60 mmHg, the frequency being toring of radioopaque or radioactive markers have approximately 2-5-3 waves min-'. The caecum provided most experimental data available on this contracts at a slightly higher frequency with waves important component of colonic activity. Thus mass of a shorter duration, whilst rectal pressures are movementstend to be stimulated by ingestion offood mostly of lower amplitude (-10 mmHg) and are and by somatic activity; they are diminished by present more continuously than those in the sigmoid. sleep (Holdstock, Misiewicz, Smith, and Rowlands, The functional significance of these differences is 1970). Mass movements are more frequent in not clear. None of these contractions are consciously diarrhoea than in constipation and treatment with perceived by the normal subject. Bursts of segmental antidiarrhoeal or laxative drugs tends respectively to activity of variable duration occur apparently at decrease or increase their occurrence. Colonic random in the basal state. In the animal small propulsion of a marker may be accelerated in a intestine the apparently random segmentation has variety of diarrhoeas, whereas small intestinal been shown by Christensen, Glover, Macagno, propulsion of the same marker appears unaltered Singerman, and Weisbrodt (1971) to depend in fact (Waller, 1973). The length of colon rapidly traversed upon the frequency plateaux of the basal electrical by a marker may be extensive in diarrhoea due to rhythm (BER), but this kind of correlation has not pathological or pharmacological causes (Misiewicz, yet been worked out for the human colon. Waller, Kiley, and Horton, 1969; Waller, 1973). The presence and amplitude of the non-propulsive More data and a better understanding ofthe pharma- segmental contractions are affected by many factors. cological control of mass movement are badly Colonic segmentation increases in response to meals needed. and diminishes during sleep. Cholinergic drugs, eg, prostigmine, augment whilst atropine-like or anti- Segmental Activity in Health cholinergic drugs inhibit segmental activity: it is http://gut.bmj.com/ also inhibited by 5-hydroxytryptamine (Misiewicz, Pressure waves recorded from the colonic lumen by Waller, and Eisner, 1966) and by bradykinin indwelling sensors represent segmental non-propul- (Murrell and Deller, 1967). Of the alimentary sive, non-peristaltic contractions of colonic muscle polypeptide hormones only gastrin and CCK have (Connell, 1961). The raised pressure is an index of been studied in any detail. Exogenous gastrin or the forces exerted by the colonic muscle on the pentagastrin do not appear to affect colonic seg- bowel contents. Muscle contractions elevate intra- mentation, but the actions of the several molecular on September 23, 2021 by guest. Protected copyright. luminal pressures when the lumen is obliterated by species of this hormone have not been investigated mucosal folds with the formation of a closed (Misiewicz, Holdstock, and Waller, 1967; Bennett, chamber, or when there is resistance to displacement Misiewicz, and Waller, 1967; Misiewicz, Waller, and of faeces because of areas of contraction elsewhere Holdstock, 1969). Injections of exogenous CCK in the bowel, or because of the high viscosity of (Harvey and
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