Ambulatory intestinal manometry: A consensus report on its clinical role

Abstract

It was clear from these discussions that there remains considerable disagreement, firstly, on what parameters of intestinal motility are of clinical relevance and, secondly, on the definition of normality. While several issues remained unresolved and must await prospective studies of the sensitivity, specificity, and reproducibility of these phenomena, agreement was reached in a number of areas. Based on these points of consensus, the following minimal criteria for an ambulatory intestinal manometry study were developed: 1. Studies should be performed with a solid-state catheter of appropriate performance characteristics and should include at least three sensors spaced at 15-cm intervals. The catheter assembly should be designed to facilitate endoscopic placement as well as passage of a guidewire for inflation of a balloon at the catheter tip. 2. The data logger should be capable of recording at a frequency of at least 4 Hz. 3. The catheter should be positioned so that its middle sensor is located at the ligament of Treitz. 4. Twenty-four-hour studies should include at least one meal taken in the evening not less than 3 hr prior to retirement. This meal should be at least 400 calories. 5. Analysis of the recording should pay attention during fasting to the frequency of the MMC and the propagation velocity of phase III of the MMC. Following meal ingestion, the ability of an appropriate meal to interrupt MMC activity and induce a fed response should be evaluated. 6. Features regarded as abnormal from such a study would include recording less than two migrating motor complexes in 24 hr, an MMC propagation velocity of less than 1.5 cm/min, a failure to abolish migrating motor complex activity for at least 180 min following an adequate meal, and an inability to generate a fed motor response. Cluster activity that lasted for more than 20 min in jejunal recording sites during fasting would also possibly be regarded as abnormal and clinically significant.