Advances in the diagnosis and classification of gastric and intestinal motility disorders

Abstract

© 2 0 1 8 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .on already available consensus statements 3,4 . Consensus statements from other gastrointestinal societies or expert groups were searched for and included when appropriate, for example, if they were published more recently or if they covered relevant areas not specifically addressed in the previous documents 3,4 . Moreover, an updated literature search using PubMed and Medline was performed centrally by the corresponding author (J.K.) with additions from the co-authors. The literature search started on the date specified as the end date of the lite ature searches performed for two previously published consensus papers 3,4 (that is, 1 Jan 2008 for intraluminal measure ments of gastrointestinal motility and 1 Jan 2010 for transit tests); the search covered the period until 14 Apr 2016 and was generally limited to human studies. The literature search revealed 1,111 publications, of which 202 were selected on the basis of study quality (which did not include a formal evaluation, but the level of evidence was assessed in line with the Oxford Centre for Evidence-based Medicine (https://www.cebm.net/2009/06/oxford-centre-evidencebased-medicine-levels-evidence-march-2009/) and were made available to all authors. Low-quality studies were also considered if the topic was deemed rele vant and not covered otherwise. The literature search on gastric emptying included the following terms, revealing 624 papers: "gastric emptying", "gastro paresis", "dumping", "measurement", "test", "evalu ation" and "diagnosis". The literature search on intra luminal tests of gastric motility included the following terms, revealing 67 papers: "gastric", "antral", "antro duo denal", "antro duodenojejunal", "motility", "contraction", "intraluminal" and "mano metry". The literature search on small bowel transit included the following terms, revealing 130 papers: "orocaecal transit", "OCCT", "small bowel transit", "intestinal transit", "measurement", "test", "evaluation", "diagnosis", "sensitivity" and "specificity". The literature search on intraluminal tests of small bowel motility included the following terms, revealing 13 papers: "small bowel", "antroduodenal", "antroduodenojejunal", " intestinal", "intraluminal", "motility" and "manometry".The literature search on colonic transit included the following terms, revealing 222 papers: "colonic transit", "Hinton", "measurement", "test", "evaluation", "diagnosis", "sensitivity" and specificity. The literature search on intraluminal tests of colonic motility included the follow ing terms, revealing 55 papers: "colonic", " motility", "contraction", "intraluminal" and "manometry".Statements were distributed via e-mail, and each author had to confirm full agreement, minor concerns or disagreement in writing. Concerns or disagreement had to be explained. All statements with at least one author in disagreement or more than three authors with minor concerns were modi...

Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

“…Nevertheless, as the rate of GE is pivotal in determining postprandial glycaemia, its measurement will still be of great importance in diabetes patients, especially those presenting with unexplained fluctuations in blood glucose levels . Consequently, the latest consensus statement on investigation of gastric motility recommends GE studies to be performed in patients with poorly controlled diabetes . Furthermore, as clinical presentation alone can rarely differentiate between rapid and delayed emptying, it is recommended to determine GE in patients with symptoms compatible with gastroparesis, where upper GI endoscopy has not provided an explanatory diagnosis .…”

“…Consequently, the latest consensus statement on investigation of gastric motility recommends GE studies to be performed in patients with poorly controlled diabetes . Furthermore, as clinical presentation alone can rarely differentiate between rapid and delayed emptying, it is recommended to determine GE in patients with symptoms compatible with gastroparesis, where upper GI endoscopy has not provided an explanatory diagnosis . This is important, as the two entities of rapid or delayed GE may respond to entirely different therapeutic approaches …”

Normative values for region‐specific colonic and gastrointestinal transit times in 111 healthy volunteers using the 3D‐Transit electromagnet tracking system: Influence of age, gender, and body mass index

“…11 One such commercially available system is the wireless motility capsule (WMC; SmartPill, Medtronic, USA), which measures whole gut and regional transit times using stereotypical changes in pH to identify the capsule's progression from one GI region to the next. 6,11 Such information can be obtained using the Motilis 3D-Transit system (Motilis Medica, SA, Lausanne, Switzerland), an emerging research tool that tracks the location and orientation of up to three ingestible electromagnetic capsules. 6,11 Such information can be obtained using the Motilis 3D-Transit system (Motilis Medica, SA, Lausanne, Switzerland), an emerging research tool that tracks the location and orientation of up to three ingestible electromagnetic capsules.…”

Gut epithelial and vascular barrier abnormalities in patients with chronic intestinal pseudo‐obstruction

“…Even extra‐GI disorders, such as diabetes mellitus and autoimmune disorders, may also show abnormalities to IEVB structure and function . Although neuro‐ICC‐muscular abnormalities represent a major factor in the pathogenesis of gut dysfunction and symptom generation in CIPO, the role of enteric luminal mechanisms, and in particular of IEVB, has never been explored in such patients. In this study, we addressed whether changes of TJ components occur in CIPO, and the possible correlations of identified IEVB‐related molecular changes to main clinical features and investigated the possible implication of mast cell infiltration, glial activation, VIP expression in IEVB integrity.…”

“…Before use, slides were deparaffinized in xylene, dehydrated through graded ethanol (both from Merck KGaA), and washed thoroughly in phosphate‐buffered saline (137mmol/L NaCl, 0.27 × 10 −3 % 2mmol/L KH 2 PO 4 ; 10mmol/L Na 2 HPO 4 ; pH 7.4, all salts purchased from Merck KGaA). To provide an adequate assessment of the neuromuscular component, sections were processed for histochemical and immunohistochemical analysis as established by guidelines from an International working team and applied in a recently published paper . Antisera were used to identify different components of the gut tissue with HRP/DAB standard method using the immunoperoxidase secondary detection system IHC Select HRP/DAB (Merck KGaA).…”