Assessment of neurogenic colon motor functions is a challenge since the colon may
not show activity for long periods of time. Appropriate stimuli are required during
assessment in order to evaluate myogenic and neurogenic functions or abnormalities.
We performed high-resolution manometry using 36 solid-state sensors, 1 cm apart in 15 patients with chronic constipation or IBS-D and volunteers. Oral prucalopride
is rapidly absorbed independent of food intake and maximal bioavailability is reached
within 1-3 hours (1). Oral prucalopride (2 mg) had a biphasic effect. A first excitation of the colon musculature was seen within
the first 20 min, and a second excitation was seen after 40 – 90 min. The first excitation produced an HAPC in 4 of 17 subjects studied at 4.1 ± 1.1 min after ingestion; or an increase in haustral boundary contractions (HC) and/or
simultaneous contractions (SC) in 7/17 was observed at 7.8 ± 3.1 min. The second excitation consisted of HAPCs in 4 out of 15 studied, at 58.0 ± 4.8 min, or HC and SCs in 11/15 at 45 ± 10 min. In all 17 subjects, baseline HAPCs were never observed and in only 1 subject
an HAPC occurred after a meal. We infer that prucalopride affects 5-HT4 receptors
on gastric or duodenal enterochromaffin cells (2) to elicit a CNS-ENS mediated gastro-colonic
reflex in addition to its prokinetic effect observed after full bioavailability is
reached. Prucalopride therefore may be useful as a test substance to evaluate the
ability to generate 5-HT4 mediated neurogenic motor patterns in the human colon. Supported
by grants from the National Natural Science Foundation of China and the Canadian Institutes
of Health Research.
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© 2015 Published by Elsevier Inc.