Time-Lapse Cincfluoro aphy in Man

J.~'~r.s Rl rcn le , M.A., D.M.

M LCH of the emphasis in motil i tv studies of the colon has been on quanti-

tative comparisons of intrahmfinal pressure records; efforts have been m a d e to find increasingly sophisticated means of measuring experimental re- suits. Th i s approach may be of great value in pha rmaco lo~c studies and in some clinical comparisons, but variat ion between individuals is so great that one can only draw conclusions from mean "moti l i ty indexes" derived from relat ively large groups of subjects.

Qual i ta t ive studies also may be useful in distinguishing between normal a n d abnormal bowel activity. At Oxford we have made studiest of coordi- n a t e d propulsion in the normal colon with time-lapse cinelluorography at I-rnln_ intervals in subjects who had swallowed 100 ml. of Micropaque bar ium suffate dispersion 12 hr. previously. These show 2 forms of propulsive move- merit . One is based on a "systolic" action of the bowel wall, by which the contents of 3 or more haustra, contracting simultaneously as a coordinated uni t , are displaced aborally into an adjoining section. T h e other is "peristal- t ic," and arises essentially as a progressive contract ion wave which advances a long the colon, usually preceded by muscular relaxation.

T h e systolic type of propulsion is chiefly seen in the first half of the colon a n d appears to be best adapted to transporting l iquid contents. Peristalsis is most common in the transverse and ¢li~tal colon, and is much more. efficient in the propulsion of solids. One or the other of these propulsive movements is l ikely tO occur about once in 6 hr., and they are usually slow-moving; mos t o f them take I0-20 min. to complete, and the bowel contents advance up t o I in . /min , over that period. When the movements are preceded or ac- companied by a tubular appearance of the bowel, they are given the name o f mass propulsion; this may transport normal bowel contents at up to 6 int./rain.

I t is possible that some of the basic defects in 2 of the most impor tant motor disorders of the colon, diverticular disease antl the irritable-colon syndrome, may be related to loc,d differences in the mechanism of propulsion. Figure I includes 9 frames from a cinefihu taken over 20 rain., which shows mass peristalsis in an ehlerlv man who had 1 normal daily bowel action. Diverticula w e r e observed in the descending and pelvic colon. T h e r e was little interference

F r o m the Nulfieht Dvpartment of Medicine. Radcliffe h~firmar), and tile Nuffiehl Institute I't~r Medical Re .a rch , Oxfgrd. England.

.~u~plx~rltai hv a grant fr~rn the Medical Research Council.

488 Amer;.n Jo~nal of Dicjest;ve Diseases

with the peristaltic movement as it l)a,~ed through tile diverticulum-bearing haustra in the descending colon, but in the Pelvic colon the peristaltic pro- gression was , topped; only when the haustrum proximal to those associated with diverticular disea.se was fur ther distended with contents from above, and responded with a systolic contraction, was the bar ium forced through the resistant section.

Williams -~ has recently shown that divertict, lar disease does not interfere with muscular relaxation ahead of a peristaltic type of propulsive movement, so that l iquid contents can be forced through divert icular segments of the bowel. Th is suggests that the obstruct ion to peristalsis of normal contents probably involves the propagation of the contraction wave itself.

T h e propulsion of solid contents against resistance by a systolic contraction of the bowel wall requires a greater mttsctdar effort than peristalsis; this causes a high local intraluminal pres, ure, and i~ may give rise to pain. An example of a painful systolic type of circular or combined muscular contraction is shown in Fig. 2.

This took place in the distal descending colon of a middle-aged patient with the irritable-colon syndrome, which had caused h im bouts of intermit tent abdomina l pain localized to this point over the previous 3-4 years. T h e figure illustrates 2 of many brief episodes of griping pain, about 15 min. apart; they represent instances in which the pain happened to coincide with a cinefluoro- gram, and in each case, the relevant frame is set between those taken 1 min. before and after it. T h e 2 series indicate that this patient 's pain was associated with a localized systolic contraction affecting 6 in. or so of the bowel, which displaced gas and l iquid contents but which failed to transport a small quant i ty of solid contents.

NuO~eld Department o[ Medicine Radcliffe lnllrmary

Oxford, England REFERENCES

1. Rrrcm~, J . .~ Colonic motor activity and bowel function. Gut In press. 2. WltuA~fS, 1. _Mass movements (mass peristalsis) and diverticular disease of the colon.

Brit ] Radiol 40:2, 1967.

[Illustrations follow]

New Ser|es, Vol. 13, No. 5, 1968 489

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