Clinical measurement of gastrointestinal motility and function: who, when and which test?

Fox, Mark; Kahrilas, Peter J.; Roman, Sabine; Gyawali, C. Prakash; Scott, S. M.; Rao, Satish S.C.; Keller, Jutta; Camilleri, Michael

doi:10.1038/s41575-018-0030-9

Cited by 53 publications

(41 citation statements)

References 141 publications

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Section: Discussionmentioning

confidence: 99%

“…High‐resolution manometry (HRM) remains the current reference standard for capturing gastrointestinal motility . Clinical uptake has been highest in the esophagus and anorectum, both easily accessible and where clinically relevant physiological data can be extracted from relatively short sections of the GI tract . Conversely, the use of manometry in the small bowel and colon remains less widely used due to its invasiveness and the cost associated with accessing these deeper regions of the GI tract .…”

Section: Discussionmentioning

confidence: 99%

“…20 Clinical uptake has been highest in the esophagus and anorectum, both easily accessible and where clinically relevant physiological data can be extracted from relatively short sections of the GI tract. 20 Conversely, the use of manometry in the small bowel and colon remains less widely used due to its invasiveness and the cost associated with accessing these deeper regions of the GI tract. 13 Beyond the practical challenges of intubation, the intrinsic complexity of these large organs themselves remains a fundamental barrier for our understanding motility in both health and disease.…”

Section: Discussionmentioning

confidence: 99%

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Spatio‐temporal motility MRI analysis of the stomach and colon

Menys¹,

Hoad

Spiller

et al. 2019

Neurogastroenterology Motil

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Background MRI is increasingly used to objectively assess gastrointestinal motility. However, motility metrics often do not offer insights into the nature of contractile action. This study introduces a systematic method of making spatio‐temporal measurements of contractions, based on changes in bowel lumen diameter. Methods Two heterogeneous cohorts of subjects were selected displaying gastric (n = 15) and colonic motility (n = 20) on which to test the spatio‐temporal motility MRI (STMM) technique. STMM involved delineating the bowel lumen along with inner and outer bowel wall along a section of the gastrointestinal tract. A series of diameter measurements were made automatically across the central axis of the lumen. Measurements were automatically propagated through the time series using a previously validated algorithm. Contractions were quantitatively summarized with two methods measuring (a) normalized contraction plot (NCP) and (b) combined velocity distance (CVD) both of which can be visualized as spatio‐temporal motility maps. Both metrics were correlated against subjective visual scoring systems. Key Results Good correlation was seen between reader scores and both motility metrics (NCP, R = 0.85, P < 0.001, CVD, R = 0.93, R < 0.001) in the gastric data. Good correlation was also seen between the reader scores and the two metrics in the colonic data (NCP, R = 0.82, P < 0.001, CVD, R = 0.78, R < 0.001). Conclusions and Inferences Spatio‐temporal motility MRI analysis of the stomach and colon correlates well with reader scores in a range of datasets and provides both a quantitative and qualitative means of assessing contractile activity in the gastrointestinal tract.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spatio‐temporal motility MRI analysis of the stomach and colon

Menys¹,

Hoad

Spiller

et al. 2019

Neurogastroenterology Motil

Self Cite

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“…There are a number of techniques to measure gastric emptying, though scintigraphy is considered to be the gold standard. 23,24 This is a noninvasive, quantitative method that involves the patient consuming a test meal consisting of 2 slices of bread with jam and 2 large eggs inoculated with 99-technetium. Scintigraphy scanning is performed at baseline and then after 30 minutes, 1 hour, 2 hours, and 4 hours postprandially.…”

Section: Figure 1 Gastric Function In Normal State (A) and In Diabetmentioning

confidence: 99%

Diabetic Gastroparesis: Perspectives From a Patient and Health Care Providers

Farmer¹,

Bruckner-Holt²,

Schwartz³

et al. 2019

Journal of Patient-Centered Research and Reviews

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G astroparesis is defined as a delay in gastric emptying in the absence of mechanical obstruction in the stomach. 1,2 Causes of gastroparesis can be postsurgical, secondary to medications (eg, opioids, anticholinergics, tricyclic antidepressants, beta-blockers, calcium channel blockers), postinfectious, idiopathic, or a complication of diabetes mellitus. The differential diagnoses of gastroparesis include cyclic vomiting syndrome and cannabinoid-induced hyperemesis. 3 The emergence of gastrointestinal (GI) complications of diabetes mellitus are a function of poor glycemic control rather than the longevity of the diagnosis. 4 The most common complication is diabetic gastroparesis (DG) and is often underrecognized. 5 The cardinal symptoms of DG are nausea, early satiety, vomiting, dyspepsia, and bloating. DG is associated with impaired glycemic control, marked psychological distress, and reduced quality of life. 6 This review paper provides a dual perspective of DG: firstly, that of the health care Abstract Gastroparesis is defined as a delay in gastric emptying in the absence of mechanical obstruction in the stomach. Gastroparesis has a number of causes, including postsurgical, secondary to medications, postinfectious, idiopathic, and as a complication of diabetes mellitus, where it is underrecognized. The cardinal symptoms of diabetic gastroparesis are nausea, early satiety, bloating, and vomiting. Diabetic gastroparesis is more common in females and has a cumulative incidence of 5% in type 1 diabetes and 1% in type 2 diabetes. It is associated with a reduction in quality of life and exerts a significant burden on health care resources. The pathophysiology of this disorder is incompletely understood. Diagnosis is made based on typical symptoms associated with the demonstration of delayed gastric emptying in the absence of gastric outlet obstruction. Gastric emptying scintigraphy is the gold standard for demonstrating delayed gastric emptying, but other methods exist including breath testing and the wireless motility capsule. Diabetic gastroparesis should be managed within a specialist multidisciplinary team, and general aspects involve dietary manipulations/nutritional support, pharmacological therapy, and surgical/endoscopic interventions. Specific pharmacological therapies include prokinetics and antiemetics, with several new medications in the drug development pipeline. Surgical/endoscopic interventions include botulinum toxin injection into the pylorus, gastric peroral endoscopic myotomy and gastric electrical stimulation. This article provides a detailed review and summary of the epidemiology, pathophysiology, investigation, and management of diabetic gastroparesis, and also gives an individual patient's perspective of living with this disabling disorder.

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“…Gastrointestinal motility disorder (caused by gastrointestinal or systemic diseases) is characterized by slow gastrointestinal motility and delayed gastric emptying and cause decreased digestive function [6,7]. Whether organic or functional, all gastrointestinal smooth muscle dyskinesias are included in gastrointestinal motility disorders [8,9].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Assessment of Fractions of Hawthorn on Gastrointestinal Motility Disorder by UPLC-MS/MS-based Metabolomics

Wang

Luo

et al. 2020

Preprint

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Background: Hawthorn, a commonly-used traditional Chinese medicine (TCM) for treating dyspepsia，dysmenorrhea and hyperlipidemia, etc., has been proven to improve gastrointestinal motility, avoid food retention. Due to its complex ingredients, the active fractions responsible for the treatment of improving digestion remain largely unknown. To explore the underlying material and interpret its potential mechanism, the therapeutic effect of extract from different polar parts of hawthorn on gastrointestinal motility disorder was studied based on the ultra-high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) metabolomics . Materials and Methods: The rat model of gastrointestinal motility disorder was established by subcutaneous injecting with atropine. The modeled rats were then treated with 4 polar parts (T1-4 in descending polarity, corresponding to water, n-butanol, ethyl acetate and petroleum ether extracts, respectively) of hawthorn for 5 consecutive days. The stomach, small intestine, plasma samples were collected and then subjected to related measurement (gastric emptying rate and small intestine propulsion rate), UPLC-MS/MS metabolic profiling and multivariate/univariate statistical analysis. Results: The results showed that T3 had the best therapeutic effect, and T1, T2 and T4 with no obvious therapeutic effect, demonstrating that the effective components of hawthorn should be compounds of medium polarity. T3 achieved good therapeutic effects due to the gastrointestinal motility promotion activity, and by rectifying the disturbed amino acid metabolism in gastrointestinal motility disorder model. Conclusion: This integrated metabolomics approach proved the validity of the therapeutic effect of extract from different polar parts of hawthorn on gastrointestinal motility disorder, providing new insights into the underlying mechanisms, and demonstrating the feasibility of metabolomics to evaluate efficacy of herbal drug, which is often difficult by traditional means.

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Clinical measurement of gastrointestinal motility and function: who, when and which test?

Cited by 53 publications

References 141 publications

Spatio‐temporal motility MRI analysis of the stomach and colon

Spatio‐temporal motility MRI analysis of the stomach and colon

Diabetic Gastroparesis: Perspectives From a Patient and Health Care Providers

Therapeutic Assessment of Fractions of Hawthorn on Gastrointestinal Motility Disorder by UPLC-MS/MS-based Metabolomics

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