The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine

Abstract

Intraluminal pressures were measured in the gastric antrum and at different levels of the upper small intestine in 18 normal subjects to investigate whether or not the interdigestive motor complex, identified in several animal species, occurs in man and, if so, to determine its characteristics. In all normal subjects, the activity front of the interdigestive motor complex was readily identified as an uninterrupted burst of rhythmic contraction waves that progressed down the intestine and that was followed by a period of quiescence. Quantitative analysis of various parameters of the complex and simultaneous radiological and manometrical observations revealed that it resembled closely the canine interdigestive motor complex. To test the hypothesis that disorders of this motor complex may lead to bacterial overgrowth in the small intestine, similar studies were performed in 18 patients with a positive 14CO2 bile acid breath test and in an additional control group of 9 patients with a normal 14CO2 breath test. All but 5 patients had normal interdigestive motor complexes. The 5 patients in whom the motor complex was absent or greatly disordered had bacterial overgrowth as evidenced by 14CO2 bile acid breath tests before and after antibiotics. These studies establish the presence and define the characteristics of the normal interdigestive motor complex in man. They also suggest that bacterial overgrowth may be due to a specific motility disorder, i.e., complete or almost complete absence of the interdigestive motor complex.