Intestinal Motility in Man

The motility of the large intestine was studied in patients with the irritable colon syndrome and patients with miscellaneous organic disorders capable of causing constipation or diarrhea to suggest that a reversible pressure gradient was, at least in part, responsible for the transport of colonic contents.

Abstract

Summary The motility of the large intestine was studied in patients with the irritable colon syndrome and patients with miscellaneous organic disorders capable of causing constipation or diarrhea. Intraluminal pressure changes were recorded from the distal colon with open-ended catheters and from the proximal colon with the radiotelemetering capsule. Compared with normal subjects patients with the spastic colon had high levels of activity in the distal colon and patients with functional diarrhea had low levels of activity. Emotion, food, and Prostigmin enhanced colonic motility in both groups of patients with the irritable colon syndrome although patients with functional diarrhea had significantly less motility than patients with the spastic colon throughout the experiments. In patients with diarrhea due to organic alimentary disease the motor activity of the distal large intestine was depressed to a similar degree as in patients with functional diarrhea. Hypermotility in response to the emotive interview occurred with similar frequency in control subjects, patients with functional diarrhea, and patients with organic diarrhea. Moreover, a clinical history of aggravation of the alimentary symptoms by emotional factors was elicited not only in patients with functional diarrhea but also in patients with diarrhea due to organic alimentary disease. It was, therefore, considered that in the irritable colon syndrome emotional stress was more commonly an aggravating factor than a fundamental cause of the disorder. Intolerance to specific items of food was present in many patients with the irritable colon syndrome. However, in individual cases the presence or absence of a clinical history of intolerance to milk or eggs did not correlate well with the motor response of the colon to these foods, nor did the effect of Prostigmin observed in this study support the concept of increased sensitivity to parasympathetic stimulation in patients with the irritable colon syndrome. Simultaneous pressure recordings from the proximal and distal large intestine suggested that a reversible pressure gradient was, at least in part, responsible for the transport of colonic contents. This pressure gradient was found to be constantly directed away from the anus in 1 patient with constipation and constantly directed toward the anus in 1 patient with diarrhea.