Topography and measurement of pyloric pressure waves and tone in humans

The topography of human pyloric pressure is ill defined, and previous studies of pyloric motility in humans have given conflicting results. A detailed profile of pyloric pressure has been recorded in seven healthy volunteers using a manometric assembly with 13 side holes spaced at 3-mm intervals on reverse aspect of a 3.5-cm long sleeve sensor. After a fasting control period of 40 min, recordings were made for 40 min during intraduodenal infusion of a lipid emulsion. Two major patterns of pressure waves were seen during the fasting control period, namely pressure waves confined to a narrow pyloric zone (isolated pyloric pressure waves) and pressure waves that were less localized and involved the antrum and/or duodenum. During lipid infusion the motility pattern was dominated by isolated pyloric pressure waves and localized pyloric tone. Ninety-two percent of the isolated pyloric pressure waves recorded by the sleeve were recorded by only one or two side holes, consistent with a phasically active zone less than 9 mm in length. Pyloric tone was confined to an even narrower zone and was most often recorded by only one side hole. When both tone and isolated pyloric pressure waves occurred together, they were recorded by the same side holes. By comparison with the side holes, the sleeve recorded 89% of isolated pyloric pressure waves and 98% of nonlocalized waves and recorded pyloric tone with a moderate sensitivity but high specificity. The technical challenge of recording localized pyloric contraction is considerable, and much of the conflict between previous studies of the human pylorus is explicable on methodological grounds.(ABSTRACT TRUNCATED AT 250 WORDS)