Imaging Measurement of Whole Gut Transit Time in Paediatric and Adult Functional Gastrointestinal Disorders: A Systematic Review and Narrative Synthesis

Abstract

Background: functional gastrointestinal disorders (FGID) are common conditions in children and adults, often associated with abnormalities of whole gut transit. Currently, transit tests can be performed using several imaging methods, including tracking of radiopaque markers, gamma scintigraphy with the use of radioisotopes, magnetic tracking methods, tracking of movement of wireless motility capsules, and emerging magnetic resonance imaging (MRI) approaches. Objectives: to review recent literature on diagnostic imaging techniques used to investigate whole gut transit in FGIDs. Methods: a systematic review was carried out. The different techniques are described briefly, with particular emphasis on contemporary literature and new developments, particularly in the field of MRI. Conclusions: emerging MRI capsule marker methods are promising new tools to study whole gut transit in FGIDs.Small intestinal bacterial overgrowth (SIBO) is another common disorder of the gastrointestinal tract. It reflects excess presence of bacteria in the small bowel, and recent studies suggest SIBO can be associated with altered gut transit [6].Constipation can be caused by slow transit of chyme within the colon. Different factors can contribute to this, including diet, lifestyle and medications [7]. Constipation can also signal the presence of other underlying disorders such as diabetes, coeliac disease and cancer [8].A recent review estimated the average prevalence of constipation at 16% worldwide [9]. In the United States, the number of hospital emergency visits linked to constipation increased by 41.5% between 2006 and 2011 [10]. Constipation is thought to be twice as common in women than in men [9]. Women at the postpartum stage (several weeks after pregnancy) are often affected by the condition, with up to 25% of women reporting the incidence of constipation [11]. Constipation rates tend to be substantially higher in the elderly population and reach up to 50-75%.Most cases of constipation are caused by one of three general mechanisms: disordered and obstructed defecation caused primarily by impaired rectal evacuation, irritable bowel syndrome with constipation, and slow transit constipation [12]. These mechanisms differ substantially, even though the general symptoms of constipation appear very similar. Proper treatment in each case calls for a patient-specific differential diagnosis. This diagnosis remains challenging and about half of all patients who complain of constipation remain unsatisfied with the treatment they receive [12].Slow transit constipation, a reduced intestine motility caused by abnormalities of the enteric nerves, accounts for 15-30% of all constipated patients, with up to 37% of constipated women affected [13].Functional constipation in childhood is very common. Its prevalence has been estimated to be 14%, forming approximately 3% of all hospital paediatric referrals [14][15][16][17][18]. In the majority of paediatric cases, constipation is not linked to specific clinical disorders but rather caused by changes i...

Feasibility Study of a New Magnetic Resonance Imaging Mini-capsule Device to Measure Whole Gut Transit Time in Paediatric Constipation

“…The x-ray ROM protocol that we have copied for this initial study (3 daily doses of 24 markers) is a common one but it is not necessarily the only one used in past literature. The new MRI mini-capsules could be used in the future with other imaging protocols such as a single dose, single imaging time point ( 9 ) and also in adults, although further investigation and validation will be needed. A new multicentre study of the mini-capsules in paediatric constipation was funded and is under way (Trial ID: ISRCTN42273449).…”

“…The intervention in this study mirrored a common x-ray ROM protocol ( 21 ). The rationale behind it is to load the GI tract with repeated daily doses of a plurality of markers to achieve a steady state and then image the location of the markers in the GI tract at predetermined time points ( 9 ). Many variants of this type of protocol have been proposed and we have chosen the one involving 3 daily doses of 24 markers each, which was also used for example for the common Sitzmarks ROMs product ( 9 , 28 ).…”

“…When some mini-capsules are remaining at day 7, their contribution to the total transit time is simply added to the count at day 4 using the same method. The principle of the WGTT marker method relies on loading of the bowel with a plurality of markers not necessarily on their specific total number ( 9 ); hence, the formula above can be adapted in case some of the mini-capsules were mistakenly not ingested, by simply changing the denominator for “the number of mini-capsules ingested over 3 days.” This happened in one instance in this study leading to one data imputation. All image data were analysed by a researcher with MRI radiographer background.…”

“…Managing this condition can be challenging. Whole gut transit time (WGTT) imaging studies have long been used ( 9 ) as an objective measure which can assist in stratifying patients and directing management. Gut transit studies have been reported to help characterize normal transit ( 10 ), anorectal retention (outlet obstruction) ( 11 ), nonretentive faecal incontinence ( 12 ), and slow transit constipation ( 11 , 13 ) and can be particularly useful when medical history and/or physical examination is unreliable ( 13 ).…”

A novel quantitative method via the degree of transverse colon ptosis for chronic constipation assessment

“…2,3 It can be caused by slow transit of chyme within the colon or impaired rectal evacuation. 4 Long-term constipation can induce abdominal distension, abdominal pain, defecation difficulty, and weakened or even absent sense of defecation.…”