Accurate localization of a fall in pH within the ileocecal region: validation using a dual-scintigraphic technique

Zárate, Natalia; Mohammed, Sahar; O'Shaughnessy, Emma; Newell, Margaret; Yazaki, Etsuro; Williams, Norman S.; Lunniss, Peter J.; Semler, John R.; Scott, S. M.

doi:10.1152/ajpgi.00127.2010

Cited by 71 publications

(75 citation statements)

References 44 publications

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“…It is known that up to 15% of subjects fail to show a characteristic sharp fall in pH at the ICJ. 11 Zarate et al 11 wondered if this is related to ileocolic valve competence. Roland et al 6 found an association between a low pressure prior to the ICJ and small intestinal bacterial overgrowth.…”

Section: Discussionmentioning

confidence: 99%

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Detecting the Non-physiological, Surgically Tailored Ileocolic Anastomosis Using the Wireless Motility Capsule. A Pre- and Post-operative, Prospective, Within Subject Trial

Thorsen

Štimec

Nesgaard

et al. 2017

J Neurogastroenterol Motil

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Background/AimsWireless motility capsule (WMC) detects the ileocolic junction (ICJ) in most non-operated patients. We find no data concerning this examination in patients where the ileocolic valve is replaced by a per definition incompetent, surgically created ICJ. We wanted to see if WMC could detect the ICJ after a right colectomy and assess the competency. MethodsProspective cohort study using a within-subject design to eliminate subject-subject variability. Selected patients operated with right colectomy underwent 3 WMC examinations (pre-operatively, 3 weeks, and 6 months after surgery). ResultsTwenty patients (8 men) included, 7 (4 men) excluded due to poor recordings (4) and unforeseen events (3). Thirteen patients (4 men), median age 63 years completed 3 tests. Median bowel lengths removed were 11 cm for ileum and 21 cm for colon. Thirty-nine examinations analyzed by 2 physicians who found all 13 ICJs at 3 examinations with high inter-rater reliability (intra-class correlation coefficient: 0.99, 0.91, and 0.99 respectively), whereas the computer found 9, 8, and 10 out of the 13 ICJs, respectively. Computed values significantly more often deviated from the 2 raters. Mean magnitude and duration of pH-drop at the ICJ (3 examinations) was 1.16-1.02-1.13 pH units and 3.15-4.78-3.75 minutes, respectively. pH-drop was smaller and duration longer at 3 weeks. We found no differences between the pre-operative (competent ICJ) and post-operative 6-month examinations (incompetent ICJ). Highest pressure immediately prior to ICJ was equal before and after surgery. Conclusion

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Section: Discussionmentioning

confidence: 99%

“…After the GE, a steady rise in the pH followed by a plateau represents the passage through the small bowel. A drop of 0.5-2.0 pH units usually occurs when the capsule enters the colon (due to bacterial fermentation), 11 thereby defining the ICJ. After the ICJ an erratic pH profile in the colon is characteristic.…”

Section: Physician-confirmed Ileocolic Junctionmentioning

confidence: 99%

Detecting the Non-physiological, Surgically Tailored Ileocolic Anastomosis Using the Wireless Motility Capsule. A Pre- and Post-operative, Prospective, Within Subject Trial

Thorsen

Štimec

Nesgaard

et al. 2017

J Neurogastroenterol Motil

View full text Add to dashboard Cite

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“…In an elegant study using radioisotopes, the pH change was validated with cecal arrival time. 8 This pH drop in the ileocecal region is a result of fermentation in cecum and short-chain fatty acids production which is maximal in this region. 9 It is possible that in 15% of subjects, this pH drop is not observed and this may be related to the ileocecal valve incompetence.…”

Section: Normal Landmarksmentioning

confidence: 99%

“…9 It is possible that in 15% of subjects, this pH drop is not observed and this may be related to the ileocecal valve incompetence. 8 Body exit time is denoted by a temperature drop to room temperature and/or loss of signal with bowel movement.…”

Section: Normal Landmarksmentioning

confidence: 99%

How to Assess Regional and Whole Gut Transit Time With Wireless Motility Capsule

Lee¹,

Erdoğan²,

Rao³

2014

J Neurogastroenterol Motil

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Assessment of transit through the gastrointestinal tract provides useful information regarding gut physiology and pathophysiology. Although several methods are available, each has distinct advantages and limitations. Recently, an ingestible wireless motility capsule (WMC), similar to capsule video endoscopy, has become available that offers a less-invasive, standardized, radiation-free and office-based test. The capsule has 3 sensors for measurement of pH, pressure and temperature, and collectively the information provided by these sensors is used to measure gastric emptying time, small bowel transit time, colonic transit time and whole gut transit time. Current approved indications for the test include the evaluation of gastric emptying in gastroparesis, colonic transit in constipation and evaluation of generalised dysmotility. Rare capsule retention and malfunction are known limitations and some patients may experience difficulty with swallowing the capsule. The use of WMC has been validated for the assessment of gastrointestinal transit. The normal range for transit time includes the following: gastric emptying (2-5 hours), small bowel transit (2-6 hours), colonic transit (10-59 hours) and whole gut transit (10-73 hours). Besides avoiding the use of multiple endoscopic, radiologic and functional gastrointestinal tests, WMC can provide new diagnoses, leads to a change in management decision and help to direct further focused work-ups in patients with suspected disordered motility. In conclusion, WMC represents a significant advance in the assessment of segmental and whole gut transit and motility, and could prove to be an indispensable diagnostic tool for gastrointestinal physicians worldwide.

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“…Changes in pH are signifi cant, ranging from pH 1 to 2 in the fasted stomach, through to pH 7 to 8 in the distal regions of the GI tract. Characteristic changes in pH are observed, including a reduction in pH, generally of at least 1 pH unit [ 16 ], in the caecum as a result of microbial activity. However, in the small intestine, inter-subject variability is low, with variation (CV%) typically less than 10 % [ 17 , 18 ] (Fig.…”

Section: Regional Variationsmentioning

confidence: 99%

Approaches to Rapid In Vivo Optimization of Hydrophilic Matrix Tablets

McDermott

Scholes

Lin

et al. 2014

Hydrophilic Matrix Tablets for Oral Controlled Release

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An effective hydrophilic matrix tablet must deliver a stable stream of active compound at an optimal rate to the gastrointestinal (GI) tract in order to achieve a benefi cial therapeutic effect. It must do this whilst moving through the GI tract, passing through a range of different environments, and experiencing environmental changes in pH, fl uid volume, fl uid composition, and physical forces, whilst also accounting for regional changes in drug absorption.In addition to this variable environment, the physico-chemical and biopharmaceutical properties of new drugs (or NCE, "new chemical entities") emerging from the industry R&D pipeline increasingly possess suboptimal solubility [ 1 ] and and/ or permeability characteristics which have an infl uence on the drug delivery. When tasked with developing a hydrophilic matrix tablet formulation, the development team must therefore rationalise these many parameters in order to meet the target product profi le (TPP).Traditional formulation development studies involve expensive and timeconsuming screening of multiple prototypes in preclinical species, in order to identify a limited number of "lead" systems to then take forward into human clinical pharmacokinetic (PK) studies (Fig. 9.1 ). This process can cost over $1.5M and take 12-15 months [ 2 ].

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Accurate localization of a fall in pH within the ileocecal region: validation using a dual-scintigraphic technique

Abstract: SM. Accurate localization of a fall in pH within the ileocecal region: validation using a dual-scintigraphic technique.

Cited by 71 publications

References 44 publications

Detecting the Non-physiological, Surgically Tailored Ileocolic Anastomosis Using the Wireless Motility Capsule. A Pre- and Post-operative, Prospective, Within Subject Trial

Detecting the Non-physiological, Surgically Tailored Ileocolic Anastomosis Using the Wireless Motility Capsule. A Pre- and Post-operative, Prospective, Within Subject Trial

How to Assess Regional and Whole Gut Transit Time With Wireless Motility Capsule

Approaches to Rapid In Vivo Optimization of Hydrophilic Matrix Tablets

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