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

Abstract

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.