Established and emerging methods for assessment of small and large intestinal motility

Background The 3D‐Transit electromagnet tracking system (Motilis Medica, SA, Lausanne, Switzerland) is an emerging tool for the ambulatory assessment of gastrointestinal (GI) transit and motility. Using this tool, we aimed to derive normative values for region‐specific colonic and GI transit times and to assess the influence of age, gender, and body mass index (BMI). Methods Regional and total colonic transit times (CTT), gastric emptying (GET), small intestinal (SITT), and whole gut (WGTT) transit times were extracted from 111 healthy volunteers from the United Kingdom and Denmark (58 female; median age: 40 years [range: 21‐88]). The effects of age, gender, and BMI were assessed using standard statistical methods. Key Results The ascending, transverse, descending, and rectosigmoid colon transit times accounted for 32%, 34%, 17%, and 17% of total CTT in females, and 33%, 25%, 14%, and 28% of total CTT in males. CTT and WGTT were seen to cluster at intervals separated by approximately 24 hours, providing further evidence of the non‐continuous nature of these measurements. Increasing age was associated with longer CTT (P = .021), WGTT (P < .001) ascending (P = .004), transverse (P < .001), and total right (P < .001) colon transit times, but shorter rectosigmoid (P = .004) transit time. Female gender was significantly associated with longer transverse (P = .049) and descending (P < .001) colon transit times, but shorter rectosigmoid (P < .001) transit time. Increasing BMI was significantly associated with shorter WGTT (P = .012). Conclusions and Inferences For the first time, normative reference values for region‐specific colonic transit have been presented. Age, gender, and BMI were seen to have an effect on transit times.

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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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

Nandhra

Mark

Tanna

et al. 2019

“…1 The reference standard for small bowel motility assessment is antroduodenal manometry. 2,3 Since detection and quantification of motility can aid in diagnosis and patient management, the use of magnetic resonance imaging (MRI) is increasingly explored for this purpose as developments in MRI techniques have made the technology more powerful whilst retaining its noninvasive and patient-friendly character. 2,3 Other techniques, such as radioopaque markers, ingestible wireless capsules, breath tests, scintigraphy and ultrasonography, have numerous limitations, challenging motility assessment in a clinical setting.…”

Section: Introductionmentioning

confidence: 99%

Assessment of fasted and fed gastrointestinal contraction frequencies in healthy subjects using continuously tagged MRI

Jonge

Sprengers

Rijn

et al. 2019

Background: Continuously tagged MRI during free breathing can assess bowel motility at frequencies as low as the slow wave, motility pattern range. This study aimed to evaluate noninvasive gastrointestinal-tagged MRI for small bowel motility assessment and to observe the physiological response to a 300-kcal meal challenge in healthy, overnight-fasted volunteers.Methods: After overnight fasting, 16 healthy subjects (7 women, mean age 25.5, range 19-37 years) underwent a free breathing, tagged MRI scan to capture small bowel motility. Each subject underwent a (a) baseline motility scan, (b) food challenge, (c) postchallenge scan, and (d) second postchallenge scan (after 20 minutes).Motility was quantified using a frequency analysis technique for measuring the spectral power of the strain, referred to as motility score. Motility score was assessed in 20 frequency intervals between 1 and 20 contractions per minute (cpm), and the data were analyzed with linear mixed-effect models. Key Result:The stimulation protocol demonstrated an immediate, food-induced, motility response in the low-frequency range (2-10 cpm), which is consistent with the stomach and small bowel frequency range (3-12 cpm). Conclusions and Inferences:This study shows that this MRI tagging technique is able to quantify the fasted-to-fed response to a 300-kcal meal challenge within the specific small bowel motility frequency range in healthy subjects. The food provocation MRI protocol provides a tool to explore the gut's response to a stimulus in specific motility frequency ranges in patients with gastrointestinal dysmotility and functional disorders. K E Y W O R D Sdynamic MRI, food challenge, motility, small bowel, SPAMM-tagged MRI This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

“…Gastrointestinal motility is complex and highly variable both within and between individuals in both health and disease. One of the key challenges faced by the research and clinical communities is the relative paucity of investigative tools . In both the upper and lower GI tract, manometry is still considered the gold standard for detailed analysis of motility, based on the assessment of intraluminal pressure change, but is invasive and burdensome from a time and cost perspective.…”

Section: Introductionmentioning

confidence: 99%

Spatio‐temporal motility MRI analysis of the stomach and colon

Menys¹,

Hoad

Spiller

et al. 2019

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.