Motility of the terminal ileum and ileocecal sphincter in healthy humans

Abstract

Factors controlling the transit of contents between the ileum and cecum should be important determinants of intestinal function; however, the dynamics of the ileocecal region remain largely unexplored in healthy humans. Accordingly, prolonged recordings of intraluminal pressure were obtained from the distal ileum, across the ileocecal sphincter, and from the proximal colon of healthy adults. In one set of studies, 16 subjects each contributed 6 h of basal, fasting recordings; in 2 of the 16, postprandial patterns were also recorded. In a second set, 6 fasting subjects were studied for a total of 120 h. Less than 10% of interdigestive cycles (migrating motor complexes) reached the ileocecal sphincter. The remainder faded out and merged into an active, apparently random pattern of pressure waves that became more intense closer to the sphincter. Discrete, short bursts of phasic pressures migrated rapidly for long distances in the distal ileum and a unique peristaltic wave also migrated rapidly, though infrequently, through the region. Tonic pressures were recorded across the ileocecal sphincter but were present only during the passage of phasic pressure waves; basal tone was minimal. We believe these are the first prolonged observations of motility from the ileocecal sphincter of healthy humans. These descriptions provide insights into and a basis for further studies of a largely unexplored area of the human bowel.