ABNORMALITIES IN PROXIMAL SMALL-BOWEL MOTILITY IN PATIENTS WITH CIRRHOSIS

Because altered intestinal motility could be involved in the pathogene sis of small intestine bacterial overgrowth observed in some patients with cirrhosis, we investigated fasting proximal small bowel motility in 16 cirrhotic patients and 8 healthy controls. In addition, the effe cts of oral tetracycline administration on duodenal motility were inve stigated in seven cirrhotic patients with evidence of bacterial overgr owth. The mean duration and characteristics of the migrating motor com plex were analyzed. Cyclic activity was observed in all healthy contro ls. It was absent in two cirrhotic patients showing a prolonged phase 2-like pattern. The duration of cycles was significantly longer in the remaining 14 patients with cirrhosis (166 +/- 19 min) compared with c ontrols (81 +/- 14 min; p < 0.02). This difference was caused by a pro longed phase 2 (138 +/- 19 min in patients with cirrhosis vs. 52 +/- 1 1 min in controls; p < 0.02). Marked changes in the contraction patter n during phase 2 were noted in cirrhotic patients. They were character ized by multiple clusters (frequency, 12 +/- 1/hr; duration, 38 +/- 3 sec) of contractions (frequency, 11 +/- 1 cpm) separated by quiescent periods (duration, 2.4 +/- 0.2 min). This motility profile filled up 5 8% +/- 8% of the total duration of phase 2, and it was observed in pat ients with and without bacterial overgrowth. Treatment with tetracycli ne was followed by only mild modifications, such as a reduction of the fraction of phase 2 occupied by multiple-clustered contractions. In c onclusion, an altered proximal small bowel motility has been observed in patients with cirrhosis. These disturbances appear not to be depend ent on the presence of bacterial overgrowth.