Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction

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.

Distinctive gastrointestinal motor dysfunction in patients with MNGIE

“…Small bowel motor activity was similar during fasting and during nutrient infusion both, in terms of global motility index (2.1 ± 1.3 and vs. 2.1 ± 0.2 contractions/min, respectively) and number of bursts (6.9 ± 1.9 vs. 7.0 ± 2.5 bursts per hour, respectively) (Figure 1). These abnormalities fulfilled the conventional criteria of neuropathic‐type intestinal dysmotility 10,11 …”

“…Manometric tracings were evaluated following dysmotility criteria previously established by conventional intestinal manometry. 10,11 High-resolution intestinal manometry patterns from MNGIE patients were also compared to a set of normal values in our laboratory from a cohort of healthy subjects obtained during fasting conditions (n = 18) and during infusion of nutrients into the duodenum (n = 16). 8,9 Computerized analysis was used obtain a global motility index, measuring the number of contractions >10 mmHg every 1 min.…”

“…These abnormalities fulfilled the conventional criteria of neuropathic-type intestinal dysmotility. 10,11 High-resolution manometry allowed a more precise characterization and provided a visual picture of the motor dysfunction in MNGIE patients, depicting the bursts as spasms of long segments of the small bowel. Each burst consisted of 4 ± 1 spastic contractions at a regular rate (every 4-5 s).…”

Transatmospheric ileal stoma manometry can be applied for the early detection of stoma outlet obstruction

“…However, stoma outlet obstruction (SOO) is a common complication of diverting ileostomy with an incidence rate from 5.6% to 18.4%, and usually develops within 2 weeks after operation (7)(8)(9). Furthermore, SOO is usually diagnosed when patients present typical symptoms of obstruction, such as abdominal pain and distention, nausea and vomiting, and can be relieved by expectant treatment such as insertion of an anal catheter to the proximal small intestine and fecal fluid will be immediately drawn out to relieve obstruction (10). SOO can cause a huge economic burden for patients due to the increased treatment costs and longer hospital stays, thus early detection of SOO can be necessary.…”

“…Although daily postoperative abdominal CT scan can reliably detect obstruction at early stage, it is not a feasible option due to tedious process and large doses of radiation. Moreover, proximal small bowel manometry has been previously used as an effective method to diagnose small bowel obstruction, and there have been studies of aberrant ileal manometry findings in irritable bowel syndrome and chronic idiopathic constipation ( 11 – 13 ). In this study, we aimed to explore the feasibility of using ileal stoma manometry for early detection of stoma obstruction after ileostomy.…”