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ON THE NATURE OF HIGH-AMPLITUDE PROPAGATING PRESSURE WAVES IN THE HUMAN COLON.

Characterization of High-Amplitude Propagating Pressure Waves (HAPWs or HAPCs) plays a key role in diagnosis of colon dysmotility using any type of colonic manometry. With the introduction of high-resolution manometry, more insight is gained into this most prominent propulsive motor pattern. Here we employ a water-perfused catheter with 84 sensors with intervals between measuring points of 1 cm throughout the colon, for 6-8 hours, in 19 healthy subjects. The catheter contained a balloon to evoke distention. We explored as stimuli a meal, balloon distention, oral prucalopride, and bisacodyl, with a goal to optimally evoke HAPWs. We developed a quantitative measure of HAPW activity, the "HAPW-Index". Our protocol elicited 290 HAPWs. 21% of HAPWs were confined to the proximal colon with an average amplitude of 75.3 ± 3.3 mmHg and an average HAPW-index of 440 ± 58 mmHg.m.s. 29% of HAPWs started in the proximal colon and ended in the transverse or descending colon with an average amplitude of 87.9 ± 3.1 mmHg and an average HAPW-index of 3344 ± 356 mmHg.m.s. 49% of HAPWs started and ended in the transverse or descending colon with an average amplitude of 109.3 ± 3.3 mmHg and an average HAPW-index of 2071 ± 195. HAPWs with and without SPWs initiated the colo-anal reflex, often abolishing 100% of anal sphincter pressure. Rectal bisacodyl and proximal balloon distention were the most optimal stimuli to evoke HAPWs. These measures now allow for a confident diagnosis of abnormal motility in patients with colonic motor dysfunction.

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