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Three distinct types of contractions perform colonic motility functions. Rhythmic phasic contractions (RPCs) cause slow net distal propulsion with extensive mixing/turning over. Infrequently occurring giant migrating contractions (GMCs) produce mass movements. Tonic contractions aid RPCs in their motor function. The spatiotemporal patterns of these contractions differ markedly. The amplitude and distance of propagation of a GMC are several-fold larger than those of an RPC. The enteric neurons and smooth muscle cells are the core regulators of all three types of contractions. The regulation of contractions by these mechanisms is modifiable by extrinsic factors: CNS, autonomic neurons, hormones, inflammatory mediators, and stress mediators. Only the GMCs produce descending inhibition, which accommodates the large bolus being propelled without increasing muscle tone. The strong compression of the colon wall generates afferent signals that are below nociceptive threshold in healthy subjects. However, these signals become nociceptive; if the amplitudes of GMCs increase, afferent nerves become hypersensitive, or descending inhibition is impaired. The GMCs also provide the force for rapid propulsion of feces and descending inhibition to relax the internal anal sphincter during defecation. The dysregulation of GMCs is a major factor in colonic motility disorders: irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and diverticular disease (DD). Frequent mass movements by GMCs cause diarrhea in diarrhea predominant IBS, IBD, and DD, while a decrease in the frequency of GMCs causes constipation. The GMCs generate the afferent signals for intermittent short-lived episodes of abdominal cramping in these disorders. Epigenetic dysregulation due to adverse events in early life is one of the major factors in generating the symptoms of IBS in adulthood.

Colon (Anatomy) --- Motility. --- Colon. --- Gastrointestinal Motility. --- Smooth muscle --- Slow waves --- Enteric neurons --- Excitation-contraction coupling --- Peristaltic reflex --- ICC --- Motility disorders --- Volume transmission --- Synaptic transmission --- Irritable bowel syndrome --- Inflammatory bowel disease --- Diverticular disease --- Diarrhea --- Constipation --- Visceral hypersensitivity --- Excitation-inhibition coupling --- Descending inhibition --- Abdominal pain --- Enteric nervous system --- Defecation

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Chronic intestinal diseases are increasing around the world. With poor quality of life and expensive healthcare costs, the patients demand novel approaches and treatments for better clinical outcomes. This book illustrates the state of the art and the envisaged near future in the management of these pathologies.

Medicine --- chronic intestinal pseudo-obstruction --- parenteral nutrition --- pediatrics --- myopathy --- neuropathy --- IBS --- microbiota --- visceral hypersensitivity --- colorectal motility --- inflammatory bowel disease --- Crohn’s disease --- ulcerative colitis --- anti-TNF --- ustekinumab --- vedolizumab --- postoperative complications --- surgery --- preoperative therapy --- biologic therapy --- bio-naïve --- IBD --- pro-inflammatory cytokines --- lymphocyte migration --- treatment --- inflammatory bowel diseases --- biologic treatment --- combination --- n/a --- Crohn's disease --- bio-naïve