Determinants of postprandial flow across the human ileocaecal junction: a combined manometric and scintigraphic study

The relationships between ileocolonic motor patterns and flow have not been defined in humans. Utilizing simultaneous ileocolonic manometry and scintiscanning, we aimed to examine this relationship and test the hypotheses that ileal propagating sequences (PSs) underlie caecal filling, that caecal filling is a stimulus for proximal colonic PSs and that the ileocolonic junction (ICJ) regulates flow between the small and large bowel. In six healthy volunteers, a 5-m-long nasocolonic manometry catheter was positioned such that 16 recording sites, spaced at 7.5-cm intervals, spanned the ileum and proximal colon. Subjects were positioned under a gamma camera 30 MBq of (99m)Tc sulphur colloid was instilled, 22.5 cm proximal to the ICJ. Isotopic images were recorded (10 s per frame) and synchronized with the manometric trace. We identified 171 ileal PSs, 47 caecal PSs and 117 discrete episodes of caecal filling. Of the 117 episodes of caecal filling, 72% were associated temporally with ileal PSs. Conversely, 87% of ileal PSs were associated with caecal filling. Of the PSs originating in the caecum, 90% were temporally associated with caecal filling. We conclude that ileal PSs are highly propulsive and are the major determinant of episodic caecal filling and that caecal filling may be a major stimulus for caecal propagating sequences.