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Manometric demonstration of duodenal/jejunal motor function consistent with the duodenal brake mechanism

Dent, John; Dinning, Philip; Corsetti, Maura; Rommel, Nathalie; Tack, Jan; Wiklendt, Lukasz; Papageorgiou, Anthony William; Arkwright, John William; Deloose, Eveline

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Authors

John Dent

Philip Dinning

MAURA CORSETTI Maura.Corsetti@nottingham.ac.uk
Clinical Associate Professor

Nathalie Rommel

Jan Tack

Lukasz Wiklendt

Anthony William Papageorgiou

John William Arkwright

Eveline Deloose



Abstract

© 2020 John Wiley & Sons Ltd Background: High-resolution manometric studies below the stomach are rare due to technical limitations of traditional manometry catheters. Consequently, specific motor patterns and their impact on gastric and small bowel function are not well understood. High-resolution manometry was used to record fed-state motor patterns in the antro-jejunal segment and relate these to fasting motor function. Methods: Antro-jejunal pressures were monitored in 15 healthy females using fiber-optic manometry (72 sensors at 1cm intervals) before and after a high-nutrient drink. Key Results: Postprandial motility showed a previously unreported transition point 18.8cm (range 13-28cm) beyond the antro-pyloric junction. Distal to the transition, a zone of non-propagating, repetitive pressure events (11.5±0.5cpm) were dominant in the fed state. We have named this activity, the duodeno-jejunal complex (DJC). Continuous DJC activity predominated, but nine subjects also exhibited intermittent clusters of DJC activity, 7.4±4.9/h, lasting 1.4±0.55minutes, and 3.8±1.2minutes apart. DJC activity was less prevalent during fasting (3.6±3.3/h; P=.04). 78% of fed and fasting state propagating antro-duodenal pressure events terminated proximally or at the transition point and were closely associated with DJC clusters. Conclusions and Inferences: High-resolution duodeno-jejunal manometry revealed a previously unrecognized transition point and associated motor pattern extending into the jejunum, consistent with the duodenal brake previously identified fluoroscopically. Timing suggests DJC activity is driven by chyme stimulating duodenal mucosal chemosensors. These findings indicate that the duodenum and proximal jejunum consists of two major functional motor regions.

Citation

Dent, J., Dinning, P., Corsetti, M., Rommel, N., Tack, J., Wiklendt, L., …Deloose, E. (2020). Manometric demonstration of duodenal/jejunal motor function consistent with the duodenal brake mechanism. Neurogastroenterology and Motility, 32(10), Article e13835. https://doi.org/10.1111/nmo.13835

Journal Article Type Article
Acceptance Date Jan 28, 2020
Online Publication Date Mar 13, 2020
Publication Date 2020-10
Deposit Date Jan 29, 2020
Publicly Available Date Mar 28, 2024
Journal Neurogastroenterology and Motility
Print ISSN 1350-1925
Electronic ISSN 1365-2982
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 32
Issue 10
Article Number e13835
DOI https://doi.org/10.1111/nmo.13835
Keywords Gastroenterology; Physiology; Endocrine and Autonomic Systems
Public URL https://nottingham-repository.worktribe.com/output/3828757
Publisher URL https://onlinelibrary.wiley.com/doi/abs/10.1111/nmo.13835
Additional Information Received: 2019-08-06; Accepted: 2020-01-28; Published: 2020-03-13

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