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ABSTRACT: The prevalence of generalized transit delay and relation to symptoms in suspected gastroparesis, intestinal dysmotility, or slow transit constipation are unknown.
The aims of this study were (1) to define prevalence of generalized dysmotility using wireless motility capsules (WMC), (2) to relate to symptoms in suspected regional delay, (3) to compare results of WMC testing to conventional transit studies to quantify new diagnoses, and (4) to assess the impact of results of WMC testing on clinical decisions.
WMC transits were analyzed in 83 patients with suspected gastroparesis, intestinal dysmotility, or slow transit constipation.
Isolated regional delays were observed in 32% (9% stomach, 5% small bowel, 18% colon). Transits were normal in 32% and showed generalized delays in 35%. Symptom profiles were similar with normal transit, isolated delayed gastric, small intestinal, and colonic transit, and generalized delay (P = NS). Compared to conventional tests, WMC showed discordance in 38% and provided new diagnoses in 53%. WMC testing influenced management in 67% (new medications 60%; modified nutritional regimens 14%; surgical referrals 6%) and eliminated needs for testing not already done including gastric scintigraphy (17%), small bowel barium transit (54%), and radioopaque colon marker tests (68%).
WMC testing defines localized and generalized transit delays with suspected gastroparesis, intestinal dysmotility, or slow transit constipation. Symptoms do not predict the results of WMC testing. WMC findings provide new diagnoses in >50%, may be discordant with conventional tests, and can influence management by changing treatments and eliminating needs for other tests. These findings suggest potential benefits of this method in suspected dysmotility syndromes and mandate prospective investigation to further define its clinical role.
Digestive Diseases and Sciences 05/2011; 56(10):2928-38. · 2.12 Impact Factor
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ABSTRACT: OBJECTIVES: Despite a lack of supportive data, stool form and stool frequency are often used as clinical surrogates for gut transit in constipated patients. The aim of this study was to assess the correlation between stool characteristics (form and frequency) and gut transit in constipated and healthy adults.
The American Journal of Gastroenterology 11/2009; 105(2):403-411. · 7.28 Impact Factor
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ABSTRACT: Despite a lack of supportive data, stool form and stool frequency are often used as clinical surrogates for gut transit in constipated patients. The aim of this study was to assess the correlation between stool characteristics (form and frequency) and gut transit in constipated and healthy adults.
A post hoc analysis was performed on 110 subjects (46 chronic constipation) from nine US sites recording stool form (Bristol Stool Scale) and frequency during simultaneous assessment of whole-gut and colonic transit by wireless motility capsule (WMC) and radio-opaque marker (ROM) tests. Stool form and frequency were correlated with transit times using Spearman's rank correlation. Accuracy of stool form in predicting delayed transit was assessed by receiver operating characteristic analysis.
In the constipated adults (42 females, 4 males), moderate correlations were found between stool form and whole-gut transit measured by WMC (r=-0.61, P<0.0001) or ROM (-0.45, P=0.0016), as well as colonic transit measured by WMC (-0.62, P<0.0001). A Bristol stool form value <3 predicted delayed whole-gut transit with a sensitivity of 85% and specificity of 82% and delayed colonic transit with a sensitivity of 82% and specificity of 83%. No correlation between stool form and measured transit was found in healthy adults, regardless of gender. No correlation was found between stool frequency and measured transit in constipated or healthy adults. The correlation between stool frequency and measured transit remained poor in constipated adults with <3 bowel movements per week.
Stool form predicts delayed vs. normal transit in adults. However, only a moderate correlation exists between stool form and measured whole-gut or colonic transit time in constipated adults. In contrast, stool frequency is a poor surrogate for transit, even in those with reduced stool frequency.
The American Journal of Gastroenterology 11/2009; 105(2):403-11. · 7.28 Impact Factor
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William L Hasler,
Richard J Saad,
Satish S Rao, Gregory E Wilding,
Henry P Parkman,
Kenneth L Koch,
Richard W McCallum,
Braden Kuo,
Irene Sarosiek,
Michael D Sitrin,
John R Semler,
William D Chey
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ABSTRACT: Relationships of regional colonic motility to transit in health, constipation, and constipation-predominant irritable bowel syndrome (C-IBS) are poorly characterized. This study aimed to 1) characterize regional differences in colon pressure, 2) relate motor differences in constipation to colon transit, and 3) quantify the role of IBS in altered contractility with constipation. Colon pH and pressure were measured by wireless capsules in 53 healthy and 36 constipated subjects. Numbers of contractions >25 mmHg and areas under curves (AUC) were calculated for colon transit quartiles by time. Constipation was classified as normal transit (<59 h), moderate slow transit (STC) (59-100 h), and severe STC (>100 h). Twelve out of 36 constipated subjects had C-IBS; 24 had functional constipation. Numbers of contractions and AUCs increased from the first to the fourth quartile in health (P < 0.0001). Mean numbers of contractions in constipated subjects were similar to controls. Mean AUCs with normal transit (P = 0.01) and moderate STC (P = 0.004) but not severe STC (P = NS) were higher than healthy subjects. IBS was associated with greater mean numbers of contractions (P = 0.05) and AUCs (P = 0.0006) vs. controls independent of transit. Numbers of contractions increased from the first to fourth quartiles in moderate STC, C-IBS, and functional constipation; AUCs increased from the first to fourth quartiles in all groups (all P < 0.05). In conclusion, colon pressure activity is greater distally than proximally in health. Constipated patients with normal or moderately delayed transit show increased motor activity that is partly explained by IBS. These findings emphasize differential effects on transit and motility in different constipation subtypes.
AJP Gastrointestinal and Liver Physiology 10/2009; 297(6):G1107-14. · 3.43 Impact Factor
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Satish S C Rao,
Braden Kuo,
Richard W McCallum,
William D Chey,
John K DiBaise,
William L Hasler,
Kenneth L Koch,
Jeffrey M Lackner,
Carrie Miller,
Richard Saad,
Jack R Semler,
Michael D Sitrin, Gregory E Wilding,
Henry P Parkman
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ABSTRACT: Colonic transit time (CTT) traditionally is assessed with radiopaque markers (ROMs), which requires radiation and is hindered by lack of standardization and compliance. We assessed regional and CTT with the SmartPill (SmartPill Corporation, Buffalo, NY), a new wireless pH and pressure recording capsule, in constipated and healthy subjects and compared this with ROM.
Seventy-eight constipated (Rome II) and 87 healthy subjects ingested a 260-kcal meal, a ROM capsule, and the SmartPill. Subjects wore a data receiver and kept daily stool diaries for 5 days. SmartPill recordings assessed CTT, whole-gut transit time (WGTT), small-bowel transit time, and gastric emptying time. Abdominal radiographs on days 2 and 5 assessed ROM transit. Sensitivity/specificity and receiver operating characteristics (ROCs) of each technique and utility were compared.
Gastric emptying time, CTT, and WGTT were slower (P < .01) in constipated subjects than controls. CTT was slower in women than men (P = .02). Day 2 and day 5 ROM transits were slower (P < .001) in constipated subjects. Correlation of the SmartPill CTT with ROMs expelled on day 2/day 5 was r = 0.74/r = 0.69 in constipation, and r = 0.70/r = 0.40 in controls, respectively. The diagnostic accuracy of the SmartPill CTT to predict constipation from ROC was 0.73, with a specificity of 0.95. These were comparable with those of day 5 ROM (ROC, 0.71; specificity, 0.95).
The SmartPill is a novel ambulatory technique of assessing regional (gastric, small bowel, colonic) and WGTT without radiation. It reveals hitherto unrecognized gender differences and upper-gut dysfunction in constipation. It correlates well with ROM and offers a standardized method of discriminating normal from slow colonic transit.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 05/2009; 7(5):537-44. · 5.64 Impact Factor
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Satish S C Rao,
Braden Kuo,
Richard W McCallum,
William D Chey,
John K DiBaise,
William L Hasler,
Kenneth L Koch,
Jeffrey M Lackner,
Carrie Miller,
Richard Saad,
Jack R Semler,
Michael D Sitrin, Gregory E Wilding,
Henry P Parkman
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ABSTRACT: BACKGROUND & AIMS:: Colonic transit time (CTT) is traditionally assessed with radioopaque markers (ROM), which requires radiation and is hindered by lack of standardization and compliance. We assessed regional and CTT with SmartPill- a new wireless pH and pressure recording capsule - in constipated and healthy subjects and compared this with ROM. METHODS:: 78 constipated (Rome II) and 87 healthy subjects ingested 260 kcal meal, one ROM capsule and SmartPill. Subjects wore data receiver and kept daily stool diaries for 5 days. SmartPill recordings assessed CTT, whole gut transit (WGTT), small bowel transit (SBTT) and gastric emptying time (GET). Abdominal x-rays on day 2 and day 5 assessed ROM transit. Sensitivity/specificity and receiver operating characteristics (ROC) of each technique and utility were compared. RESULTS:: GET, CTT and WGTT were slower (p<0.01) in constipated subjects than controls. CTT was slower in women than men (p=0.02). Day 2 and day 5 ROM transit were slower (p<0.001) in constipation. Correlation of SmartPill CTT with ROM expelled on day 2/day 5 were r=0.74/r=0.69 in constipation, and r=0.70/r=0.40 in controls. Diagnostic accuracy of SmartPill CTT to predict constipation from ROC was 0.73 with specificity of 0.95. These were comparable to those of day 5 ROM (ROC=0.71; specificity = 0.95). CONCLUSIONS:: SmartPill is a novel ambulatory technique of assessing regional (gastric, small bowel, colonic) and WGTT without radiation. It reveals hitherto unrecognized gender differences and upper gut dysfunction in constipation. It correlates well with ROM and offers standardized method of discriminating normal from slow colonic transit.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 02/2009; · 5.64 Impact Factor
