Gut, 1970, 11, 41-46 Physial fators in the stimulation of oloni peristalsis J. D. HRDSTLE ND. V. MNN From St Mark's Hospital, London, and The London Hospital SUMMRY The effet of oloni distension and hanges in intraluminal ph and osmolality have been investigated in patients with well established olostomies. Small volumes of aidi buffer (ph4) and hypertoni saline (4 %) were found to be only a very weak peristalti stimulus. Strong hypertoni solutions (glyerine P) indued a poorly sustained peristalti response in the majority of ases. Distension of the inative olon did not stimulate peristalsis. Distension of a olon previously stimulated to peristalti ativity aused fresh waves of ontration. This study appears to show that by themselves physial fators play an unimportant role in initiating peristalti ativity in the olon. oloni peristalsis an be stimulated by the use of surfae-ating agents suh as bisaodyl and oxyphenisatin (Hardastle and Mann, 1968). Little is known, however, of the fators whih initiate spontaneous peristalsis. This study was undertaken to investigate the role of oloni distension and hanges of intraluminal ph and osmolality in the stimulation of peristalsis. Methods Intraluminal oloni pressures were reorded using small air-filled latex balloons (0.4 x 0.8 m) introdued into the bowel through well established olostomies, in a manner similar to that previously desribed (Hardastle and Mann, 1968). Only healthy bowel has been studied. The transverse olostomies were performed to defuntion the bowel after resetion of arinoma of the retum and the sigmoid olostomies were established after exision of the retum for arinoma. Only one study was performed on eah patient (Table I). Stimulus Studied Peristalti Response Peristalti No. of Response in Patients Positive Negative Sensitized Studied olon idi buffer 6 2 8 4% Sodium hloride 6 6 Glyerine 6 2 8 Glyerine suppository 8 8 Gelatin suppository 3 3 Distension 11 1 12 Table I Results Summary of responses to various stimuli EFFET OF HNGE OF INTRLUMINL ph The effet of introduing 4-6 ml of phosphate buffer, ph4, into the lumen of the olon was studied in eight patients. On six oasions no hange in bowel ativity was noted (Fig. 1) although the olon responded by peristalsis to subsequent intraluminal bisaodyl. On two oasions, poorly sustained peristalsis was noted, but on one of these, peristalsis had already been observed before the introdution of the aidi buffer solution (Fig. 2).
42 J. D. Hardastle and. V. Mann SLINE 4 ml. l ISOTONI UFFER 4.m. ph 40, 't_~ -. _-- --, ISODYL 3ng. a L L_ a a a Fig. 1 Effet of aid buffer on the olon. 0,^ h.. _,. a. \ \ /SLINE ISOTONI UFFER \ ^ J} O~~ ~ ~ ~~~Ml. ph 4.0 ISODYL 3 mg..._ 1. Fig. 2 Effet of aidi solutions on olon previously sensitized to peristalti ativity.
43 Physial fators in the stimulation of oloni peristalsis \ \7SO/ISODIUM 1 D 4% GLYERINE ~~~ - ~ ~ HYPERTONI SODIUM PHOSPHTE 4ml. ISODYL D -n Fig. 3 Effet of hypertoni solutions on the olon. GLYERINE ISODYL 3 ml.. 3mg. 4mng. Fig. 4 Effet ofglyerine on the olon.
44 J. D. Hardastle and. V. Mann GELTIN SUPPOSITORY INSERTED GELTIN OOZING OUT GLYERINE SUPPOSITORY INSERTED EXPELLED GLYERINE SUPPOSITORY RE-INSERTED EXPELLED 1 1 I I Fig. 5 Effet ofgelatin and glyerine suppositories on the olon. ISODYL \7 Jn 50 mi. 3 mg. Gut: first published as 10.1136/gut.11.1.41 on 1 January 1970. Downloaded from http://gut.bmj.om/ somi. 50 mi. on 8 Marh 2019 by guest. Proteted by opyright. Fig. 6 Effet ofdistension on the olon.
45 Physial fators in the stimulation of oloni peristalsis I 25 ml. LLOON INSERTED I Fig. 7 Effet of distension on olon previously sensitized to peristalti ativity. 1 50mi. l I D S DL 25 h. 1 1 --- EFFET OF HNGE OF INTRLUMINL OSMOLLITY The effet of intraluminal 4% sodium hloride (4-8 ml) was studied in six patients. No propagated ativity was observed, although loal inrease in ativity was seen (Fig. 3). Intraluminal glyerine (3 ml) stimulated a poorly sustained peristalti response in six subjets (Fig. 4); no response was noted in two other patients (Fig. 3). The introdution of glyerine suppositories into the olon aused limited peristalti ativity whih usually resulted in expulsion of the suppository from the olostomy. Suppositories made only of gelatine and water did not stimulate peristalsis (Fig. 5). EFFET OF OF THE OLON The effet of distension of the olon has been investigated in 12 patients using rapid distension of a thin latex balloon with 50 ml of air as the distending stimulus. In 11 patients, peristalsis was not stimulated (Fig. 6). In the study illustrated in Fig. 7, peristalsis was observed during the ontrol period of observation; in this ase insertion of the latex ballon and its subsequent inflation stimulated waves of peristalsis. In all ases after peristalsis had been indued by bisaodyl, further waves of 1 25.m. l IISODYL 3mg. I J _Lr ontration ould be indued by distension (Fig. 6). Disussion In isolated oloni loops N/100 hydrohlori aid has been shown to inrease the rate of movement of fluid through the bowel (Hukuhara, Nakayama, and Nanba, 1961). The ph of the buffer solution used in this study was maintained at 4.0, a level well below the normal ph of the ontents of the olon (Kitagawa, Nishigori, Murata, Nishimoto, and Takada, 1966) and the volumes used were so small that signifiant distension was not produed. idi fluid used in this fashion proved to be only a very weak peristalti stimulus. Small volumes of 4% sodium hloride did not stimulate oloni peristalsis; as the ioni ontent of this solution is greatly in exess of that found in the terminal ileum (Kanaghinis, Lubran, and oghill, 1963), it seems unlikely that hanges in osmolality stimulate spontaneous peristalsis. However, extremely hypertoni solutions suh as glyerine stimulate a poorly sustained peristalti response and this would appear to be the meh-
46 J. D. Hardastle and. V. Mann anism by whih glyerine suppositories exert their effet. The olon has been shown to aept a distending balloon with only slight inreases in loal ativity unless the bowel has been previously sensitized either through endogenous fators or by the use of exogenous stimulants suh as isaodyl. Physial stimuli would thus appear to play little part in stimulating spontaneous peristalsis in man but may be important in reating further waves of ontration in bowel that has already been onditioned by other fators in the ileal dejeta. We should like to thank Dr E. N. Rowlands and the MR Gastroenterologial Researh Unit at the entral Middlesex Hospital for providing the Shwarzer pressure reording apparatus used in this and the previous study, and oehringer Ingelheim Ltd for providing a supply of isaodyl (Dalolox). Referenes Hardastle, J. D., and Mann,. V. (1968). Study of large bowel peristalsis. Gut, 9, 512-520. Hukuhara, T., Nakayama, S., and Nanba, R. (1961). The role of the intrinsi muosal reflex in the fluid transport through the denervated oloni loop. Jap. J. Physiol., 11, 71-79. Kanaghinis, T., Lubran, M., and oghill, N. F. (1963). The omposition of ileostomy fluid. Gut, 4, 322-338. Kitagawa, K., Nishigori,., Murata, N., Nishimoto, K., and Takada, H. (1966). Radiotelemetry of the ph of the gastrointestinal trat by glass eletrode. Gastroenterology, 51, 368-372. Gut: first published as 10.1136/gut.11.1.41 on 1 January 1970. Downloaded from http://gut.bmj.om/ on 8 Marh 2019 by guest. Proteted by opyright.