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The migrating motor complex: control mechanisms and its role in health and disease

Abstract

The migrating motor complex (MMC) is a cyclic, recurring motility pattern that occurs in the stomach and small bowel during fasting; it is interrupted by feeding. The MMC is present in the gastrointestinal tract of many species, including humans. The complex can be subdivided into four phases, of which phase III is the most active, with a burst of contractions originating from the antrum or duodenum and migrating distally. Control of the MMC is complex. Phase III of the MMC with an antral origin can be induced in humans through intravenous administration of motilin, erythromycin or ghrelin, whereas administration of serotonin or somatostatin induces phase III activity with duodenal origin. The role of the vagus nerve in control of the MMC seems to be restricted to the stomach, as vagotomy abolishes the motor activity in the stomach, but leaves the periodic activity in the small bowel intact. The physiological role of the MMC is incompletely understood, but its absence has been associated with gastroparesis, intestinal pseudo-obstruction and small intestinal bacterial overgrowth. Measuring the motility of the gastrointestinal tract can be important for the diagnosis of gastrointestinal disorders. In this Review we summarize current knowledge of the MMC, especially its role in health and disease.

Key Points

  • The migrating motor complex (MMC) is a cyclic motor pattern in the gastrointestinal tract that occurs during the interdigestive state in humans and other animals

  • Levels of endogenous motilin fluctuate together with the different MMC phases, and exogenously administered motilin can induce phase III contractions

  • Exogenously administered ghrelin induces phase III contractions; detailed studies of fluctuations of endogenous ghrelin levels with the MMC phases in humans are lacking

  • Serotonin and somatostatin inhibit the occurrence of antral phase III contractions and redirect the origin of these contractions towards the duodenum

  • Vagotomy abolishes the MMC pattern in the stomach, but has a minimal effect on the small bowel pattern

  • The activity of the MMC is a clinical marker for the functionality of the gastrointestinal tract, and several disorders are linked to a disturbed MMC

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Figure 1: High-resolution manometry recording of the MMC in humans.
Figure 2: Schematic representation of potential mechanisms involved in the generation of the MMC in humans.

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Acknowledgements

The main draft of this manuscript was written when all authors worked at the Translational Research Center for Gastrointestinal Disorders (TARGID), Catholic University of Leuven, Belgium. Since that time P. Janssens has moved to work for Shire. See the article online for full author biographies.

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Deloose, E., Janssen, P., Depoortere, I. et al. The migrating motor complex: control mechanisms and its role in health and disease. Nat Rev Gastroenterol Hepatol 9, 271–285 (2012). https://doi.org/10.1038/nrgastro.2012.57

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