Basal pressure patterns and reflexive motor responses in the human ileocolonic junction

Abstract

This study aimed to determine whether a sustained high-pressure zone exists at the human ileocolonic junction (ICJ) and whether the motor responses of ICJ are consistent with sphincteric function. In 10 subjects with temporary ileostomies, a high-pressure zone was identified using a manometric pull-through with a mean pressure of 9.7 ± 3.2 mmHg and length of 4.8 ± 1.2 cm. Prolonged recordings using a sleeve sensor confirmed sustained tone in the ICJ and superimposed phasic pressure waves (4–8 counts/min) occupying 35% of fasted state. A meal increased ICJ tone ( P = 0.0001) and the proportion of time occupied by phasic activity to 50% ( P = 0.013). Terminal ileal propagating pressure wave sequences inhibited ICJ phasic activity, and sequences not extending to the cecum reduced ICJ tone (9.0 ± 7.2 to 5.6 ± 6.3 mmHg; P = 0.04). Cecal distension increased ICJ tone (8.9 ± 4.4 mmHg to 11.7 ± 4.9 mmHg; P = 0.005). The ICJ response to ileal distension was variable and depended on resting tone at the time of distension. We conclude that the human ICJ has sustained tone with superimposed phasic activity. Tone is augmented by cecal distension or a meal and is inhibited by ileal propagating pressure waves. Response to ileal distension is variable but suggests control by descending excitatory and inhibitory pathways.