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Migrating Motor Complex (MMC)

The migrating motor complex is a cyclic pattern of gastrointestinal contractions occurring during the fasting or interdigestive period. It starts in the stomach or duodenum and propagates through the small intestine about every 90 to 120 minutes.
It is termed the intestinal “housekeeper” because it clears residual food particles, mucus, cellular debris, and bacteria from the stomach and small intestine.
Phases of MMC:
  1. Phase I: Motor quiescence with little or no contraction.
  2. Phase II: Intermittent, irregular contractions of increasing frequency.
  3. Phase III: Short burst of regular, powerful, propagated peristaltic contractions. This is the cleansing phase.
  4. Phase IV: Brief transition from phase III back to phase I.
Regulation:
  • Mainly associated with cyclic release of motilin.
  • Erythromycin, a motilin-receptor agonist, can induce MMC-like activity.
  • Feeding interrupts the MMC and replaces it with the fed pattern of irregular contractile activity.
Functions:
  • Moves undigested residue towards the colon.
  • Limits small-intestinal bacterial colonization.
  • Loss or impairment may contribute to small intestinal bacterial overgrowth, gastroparesis, and intestinal dysmotility.
Reference: Schwartz’s Principles of Surgery, 11th ed., p. 1140. The NCBI review of MMC physiology also describes its fasting occurrence and the high-amplitude propagated contractions of phase III.
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