The assessment of regional gut transit times in healthy controls and patients with gastroparesis using wireless motility technology

Abstract

BACKGROUND Wireless pH and pressure motility capsule (wireless motility capsule) technology provides a method to assess regional gastrointestinal transit times. AIMS Data from a multi-center study of gastroparetic patients and healthy controls was analyzed to: compare regional transit times measured by wireless motility capsule in healthy controls and gastroparetics (GP). METHODS 66 healthy controls and 34 patients with GP [15 diabetic and 19 idiopathic] swallowed wireless motility capsule together with standardized meal (255 kcal). Gastric emptying time (GET), small bowel transit time (SBTT), colon transit time (CTT), and whole gut transit time (WGTT) were calculated using the wireless motility capsule. RESULTS GET, CTT and WGTT but not SBTT were significantly longer in GP than in controls. Eighteen percent of gastroparetic patients had delayed WGTT. Both diabetic and idiopathic etiologies of gastroparetics had significantly slower WGTT (p<0.0001) in addition to significantly slower GET than healthy controls. Diabetic gastroparetics additionally had significantly slower CTT than healthy controls (p = 0.0054). CONCLUSIONS 1) In addition to assessing gastric emptying, regional transit times can be measured using wireless motility capsule. 2) The prolongation of CTT in gastroparetic patients indicates dysmotility beyond the stomach in GP is present and could be contributing to symptom presentation.

Connecting the Dots Between Gastrointestinal Motility and Symptoms Using Wireless Motility Capsule Testing

“…They characterize their patients with suspected motility disorders using WMC testing, reporting multiregional dysmotility in nearly half of their sizable population of patients with upper and lower GI symptoms, in concordance with previous studies [4][5][6]. Evaluating the global gut motility profile of these patients can be helpful in aiding clinicians to determine whether there is a focused or diffuse sensory or motility process leading to symptom generation, so that appropriate treatments can be instituted.…”

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

“…As such, WMC will not be able to characterize propagation and certain contractile patterns in the small and large bowel including migrating motor complex and propagating contractions. Despite this limitation, there have been a number of studies that suggest pressure measurement with WMC may have a complementary role to measurement of transit including predicting severity of gastroparesis 6 and providing mechanistic insight to slow-transit constipation. 18,19 Other uses of WMC have included assessment of new drug effects on GI transit and their mechanisms of action.…”

“…The median SBTT in healthy volunteers is reported to be 4.6 hours (range 4.0-5.9 hours, 25th and 75th percentiles), 6 with rapid transit defined as less than 2.5 hours and delayed transit as more than 6 hours. There was a significant correlation in SBTT measured with the capsule and whole gut scintigraphy in normal volunteers (r = 0.69).…”

“…The abrupt pH rise marks the passage of capsule from the antrum into the duodenum. 6 The use of proton pump inhibitors may affect the magnitude of pH change, and therefore it should be avoided. One study showed that despite the use of proton pump inhibitors there was an abrupt and persistent pH change of ＞ 0.5 unit coinciding with capsule entry into the duodenum.…”

Extending in vitro digestion models to specific human populations: Perspectives, practical tools and bio-relevant information

“…Such insights include not just understanding of food breakdown but also its impact on gastro-intestinal functions, e.g. gastric emptying and intestinal motility, as detailed by others (Grundy et al, 2016;Houghton, Hickson, & Read, 1987;Meyer, Elashoff, & Lake, 1999;Sarosiek et al, 2010).…”