MMC‐related duodenojejunal antegrade and retrograde peristalsis in humans

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Abstract
According to recent manometric studies the last part of phase III of the migrating motor complex (MMC) shows the features of a retroperistaltic pump in the proximal duodenum in most healthy humans. In the present study, individual contractions in phase II and phase III of the MMC were investigated in ten healthy subjects (four males, six females), focusing on the distal duodenum and the jejunum. Motility was recorded on two different days with eight‐channel catheters. On one day a standard antroduodenojejunal fasting recording was performed for 5 h, allowing detailed analysis of pressure waves in the proximal duodenum. On another day a two‐station measurement was performed in the proximal jejunum and the distal duodenum. The propagated pressure waves were analysed for late phase II (last 30 min) and for the first and the last part (I min) of phase III in the three intestinal segments. Antegrade peristalsis predominated at all levels in phase II and in the first part of phase III. In contrast, 84 ± 11% of all propagated contractions were retrograde in the last part of phase III in the proximal duodenum and 75 ± 16% in the distal duodenum. The proportions of retrograde contractions in early phase III and in late phase III differed significantly, from 11 ± 11% to 84 ± 11% and from 32 ± 16% to 75 ± 16% in the proximal and distal duodenum, respectively (P < 0.01 and P < 0.05). In the proximal jejunum such retroperistalsis was not observed, neither in the beginning nor at the end of phase III. In phase II the proportions of retrograde pressure waves were small (3–10%) in the three segments studied. The migration velocity of the pressure waves showed a gradient in this phase, with the lowest values in the jejunum.It is concluded that the last part of phase III shows the pressure pattern of a retroperistaltic pump through out the duodenum. In contrast, no distinct MMC‐related retroperistalsis was observed in the jejunum.