Characterization of a Duodenal Propagating Wave Identified on High-Resolution Antroduodenal Manometry During the Digestive Phase.

BACKGROUND

The duodenal digestive phase shows irregular non-propagating pressure contractions on antroduodenal manometry (ADM). This study aims to characterize a specific duodenal wave during this phase using high-resolution ADM (HR-ADM).

METHODS

Twenty HR-ADM traces were analyzed. Duodenal waves were identified during meal ingestion and postprandially and assessed for: peaks/min, mean amplitude, area under the curve (AUC), frequency, propagation length, and velocity. Wave parameters and characteristics are described and compared according to patient symptomatology.

KEY

RESULTS

Median patient age was 16 years (range 4-19), with 70% female. A total of 292 duodenal waves were identified: 142 during the meal and 150 postprandially. Wave parameter and characteristics by phase were: meal (4.4 ± 1.3 peaks/min, mean amplitude 30.9 ± 5.9 mmHg, AUC 295 ± 98.2 mmHg*s, frequency 0.23 ± 0.1 waves/min, 15.7 ± 4.4 cm propagation length, 1.6 ± 1.2 cm/s velocity) and postprandial (3.8 ± 1.3 peaks/min, mean amplitude 32 ± 6.4 mmHg, AUC 245.9 ± 76.2 mmHg*s, frequency 0.12 ± 0.07 waves/min, 17.4 ± 4.5 cm propagation length, 1.5 ± 0.2 cm/s velocity). All waves had antegrade propagation and were interspersed with semental non-propagating contractions. The wave AUC (p = 0.008) and frequency (p < 0.001) were significantly higher during the meal, while propagating length was longer postprandially (p = 0.009) on paired sample analysis. The wave frequency (p < 0.001) and AUC (p = 0.043) were significantly higher during the meal on independent sample analysis. No significant difference was found on the rest of the parameters or according to symptom type.

CONCLUSION AND INFERENCES: This study describes an antegrade propagating duodenal wave during the digestive phase, which may facilitate nutrient movement to the distal small bowel.