Clinical value of motor function of digestive system investigation: past, present and future

The aim of review. To demonstrate modern methods of investigation of motor function of the esophagus, stomach, small and large intestine, anorectal area and their clinical value.

Key points. First attempts to study qualitative and quantitative indicators of gastro-intestinal motor function were undertaken by clinicians in 80ies years of XIX century. Nowadays investigation of motor function of the esophagus can by carries out both by open catheter method (water perfused manometry), and by the newest hi-tech method – high resolution manometry (HRM) and volume 3D manometry. Combined recording of HRM and impedance allows to carry out differential diagnostics at belching, to detect aerophagy that helps to individualize treatment of the patient. The «gold standard» diagnostics of stomach motor disorders is radioisotope imaging. High resolution manometry allows to assess contractile function of pyloric part of the stomach, to reveal disorders of antroduodenal coordination. С13-octanoic acid breath test, ultrasound investigation, single-photon emission computed tomography, magnetic-resonance tomography are widely applied as well. Myoelectric activity of the stomach and small intestine can be analyzed by electrogastroenterography method. To study motor function of the colon and anorectal area defecography, intestinal transit time investigation with application of radioactive labels, balloon expulsion test, sphincter profilometry, large intestine manometry by solid-state catheter and other studies are performed. High resolution anorectal manometry is an up-to-date method of anorectal motor activity rating, that is practiced in specialized research centers. This method allows to estimate obturative function of rectal sphincter, intestinal component of stool continence.

Conclusion. Clinical value of digestive system motor function investigation grows steadily and skill to diagnose disorders of peristaltic activity according to symptoms can and should be complemented by with modern methods of esophageal, gastric and intestinal motor activity registration.

1. Василенко В.Х., Гребенев А.Л., Сальман М.М. Болезни пищевода. – М.: Медицина, 1971. – 407 с.

2. Гребенев А.Л. Клиническое значение исследований двигательной функции пищевода: Автореф. дис. … канд. мед. наук. – М., 1964. – 23 с.

3. Ивашкин В.Т., Трухманов А.С. Эволюция представлений о роли нарушений двигательной функции пищевода в патогенезе гастроэзофагеальной рефлюксной болезни // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2010. – Т. 20, № 2. – С. 13–19.

4. Панцырев М.Ю., Климинский И.В., Чернякевич С.А. Иономанометрическое исследование пищеводно-желудочного перехода: Методические рекомендации. – М., 1976. – 37с.

5. Сторонова О.А., Трухманов А.С. Методика изучения двигательной функции пищевода: Пособие для последипломного образования / Под ред. В.Т. Ивашкина. – М.: Медпрактика-М, 2011. – 34 p.

6. Фоменко О.Ю., Подмаренкова Л.Ф., Титов А.Ю. и др. Алгоритм исследования нарушений запирательного аппарата прямой кишки при функциональной недостаточности анального сфинктера // Рос. журн. гастроэнтерол. гепатол. колопроктол. – 2009. – Т. 19, № 4. – С. 62–68.

7. Чернякевич С.А. Моторная функция верхних отделов пищеварительного тракта в норме и при патологии // Рос. журн. гастроэнтерол., гепатол., колопроктол. – 1998. – Т. 18, № 2. – С. 33–39.

8. Bouras E.P. et al. SPECT imaging of the stomach: comparison with barostat // Gut. – 2002. – Vol. 51. – P. 781–786.

9. Desipio J. et al. High-resolution solid-state manometry of the antropyloroduodenal region // Neurogastroenterol. Motil. – 2007. – Vol. 19. – P. 188–195.

10. Ghosh S.K., Pandolfino J.E., Zhang Q. et al. Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry // Am. J. Physiol. Gastrointest. Liver Physiol. – 2006. – Vol. 291 (3). – P. 525–531.

11. Kahrilas P.J., Ghosh S.K., Pandolfino J.E. Esophageal motility disorders in terms of pressure topography: the Chicago classification // J. Clin. Gastroenterol. – 2008. – Vol. 42. – P. 627–635.

12. Satish S.C. Rao, Kalyani Meduri. Research Fellow. What is necessary to diagnose constipation? // Best Pract. Res. Clin. Gastroenterol. – 2011. – Vol. 25. – P. 127–140.

13. Scott S.M., Gladman M.A. Manometric, sensorimotor, and neurophysiologic evaluation of anorectal function // Gastroenterol. Clin. North Am. – 2008. – Vol. 37 (3). – P. 511–538.

14. Simonian H.P. et al. Simultaneous assessment of gastric accommodation and emptying: Studies with liquid and solid meals // J. Nucl. Med. – 2004. – Vol. 45 (7). – P. 1155–1160.

15. Sun W.M., Rao S.S. Manometric assessment of anorectal function // Gastroenterol. Clin. North Am. – 2001. – Vol. 30 (1). – P. 15–32.

16. Yu Tien Wang, Etsuro Yazaki, Daniel Sifrim. Highresolution manometry: Esophageal disorders not addressed by the «Chicago classification» // J. Neurogastroenterol. Motil. – 2012. – Vol. 18 (4). – P. 365–372.