Information de reference pour ce titreAccession Number: | 01817247-200905000-00016.
|
Author: | Rao, Satish S.C. *,*; Kuo, Braden ++; McCallum, Richard W. [S]; Chey, William D. ∥; DiBaise, John K. [P]; Hasler, William L. ∥; Koch, Kenneth L. #; Lackner, Jeffrey M. **; Miller, Carrie **; Saad, Richard ++++; Semler, Jack R. #; Sitrin, Michael D. **; Wilding, Gregory E. **; Parkman, Henry P. *
|
Institution: | (*)Department of Medicine, University of Iowa, Iowa City, Iowa (++)Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts ([S])Department of Medicine, Kansas University Medical Center, Kansas City, Kansas (∥)Department of Medicine, University of Michigan, Ann Arbor, Michigan ([P])Department of Medicine, Mayo Clinic, Scottsdale, Arizona (#)The SmartPill Corporation, Buffalo, New York (**)Department of Biostatistics, State University of New York at Buffalo, Buffalo, New York (++++)Department of Medicine, Temple University, Philadelphia, Pennsylvania
|
Title: | |
Source: | Clinical Gastroenterology & Hepatology. 7(5):537-544, May 2009.
|
Abstract: | Background & Aims: 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.
Methods: 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.
Results: 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).
Conclusions: 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.
(C) 2009Elsevier, Inc.
|
References: | 1. Rao SS. Constipation: evaluation and treatment of colonic and anorectal motility disorders. Gastroenterol Clin North Am. 2007;36:687-711.
2. Diamant ND, Kamm MA, Wald A, et al. AGA technical review on anorectal testing techniques. Gastroenterology. 1999;116:735-760.
3. Rao SSC, Mudipalli RS, Stessman M, et al. Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus). Neurogastroenterol Motil. 2004;16:1-8.
4. Glia A, Lindberg F, Nilsson LH, et al. Clinical value of symptom assessment in patients with constipation. Dis Colon Rectum. 1999;42:1401-1408.
5. Rao SSC, Ozturk R, Laine L. Clinical utility of diagnostic test for constipation in adults: a systematic review. Am J Gastroenterol. 2005;100:1605-1615.
6. Hinton JM, Lennard-Jones JE, Young AC. A new method for studying gut transit times using radio-opaque markers. Gut. 1969;10:842-847.
7. Evans RC, Kamm MA, Hinton JM, et al. The normal range and a simple diagram for recording whole gut transit time. Int J Colorectal Dis. 1992;7:15-17.
8. Metcalf AM, Phillips SF, Zinsmeister AR, et al. Simplified assessment of segmental colonic transit. Gastroenterology. 1987;92:40-47.
9. Nam YS, Pikarsky AJ, Wexner SD, et al. Reproducibility of colonic transit study in patients with chronic constipation. Dis Colon Rectum. 2001;44:86-92.
10. Lin HC, Prather C, Fisher RS, et al. Measurement of gastrointestinal transit. Dig Dis Sci. 2005;50:989-1004.
11. Camilleri M, Zinsmeister AR. Towards a relatively inexpensive, noninvasive, accurate test for colonic motility disorders. Gastroenterology. 1992;103:36-42.
12. Lundin E, Graf W, Garske U, et al. Segmental colonic transit studies: comparison of a radiological and a scintigraphic method. Colorectal Dis. 2007;9:344-351.
13. Cremoni F, Mullan BP, Camilleri M, et al. Performance characteristics of scintigraphic transit measurements for studies of experimental therapies. Aliment Pharmacol Ther. 2002;16:1781-1790.
14. Kuo B, McCallum RW, Koch KL, et al. Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther. 2007;27:186-196.
15. Cassilly DW, Kantor S, Knight LC, et al. Gastric emptying of a non-digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy. Neurogastroenterol Motil. 2008;20:311-319.
16. Sadik R, Stotzer PO, Simren M, et al. Gastrointestinal transit abnormalities are frequently detected in patients with unexplained GI symptoms at a tertiary centre. Neurogastroenterol Motil. 2008;20:197-205.
17. Thompson WG, Longstreth GF, Drossman DA, et al. Functional bowel disorders and functional abdominal pain. Gut. 1999;45:1143-1147.
18. Locke GR, Talley NJ, Weaver AL, et al. A new questionnaire for gastroesophageal reflux disease. Mayo Clin Proc. 1994;69:539-547.
19. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32:920-924.
20. Evans DF, Pye G, Bramley R, et al. Measurement of gastrointestinal pH profiles in normal ambulant human subjects. Gut. 1988;29:1035-1041.
21. Fallingborg J, Christensen LA, Ingeman-Nielsen M, et al. pH-profile and regional transit times of the normal gut measured by a radiotelemetry device. Aliment Pharmacol Ther. 1989;3:605-613.
22. Gehan E. A generalized Wilcoxon test for comparing arbitrarily singly-censored samples. Biometrika. 1965;52:203-223.
23. Karlbom U, Pahlman L, Nilsson S, et al. Relationships between defecographic findings, rectal emptying, and colonic transit time in constipated patients. Gut. 1995;36:907-912.
24. Datz FL, Christian PE, Moore J. Gender-related differences in gastric emptying. J Nucl Med. 1987;28:1204-1207.
25. Hinds JP, Stoney B, Wald A. Does gender or the menstrual cycle affect colonic transit? Am J Gastroenterol. 1989;84:123-126.
26. Degen LP, Phillips SF. Variability of gastrointestinal transit in healthy women and men. Gut. 1996;39:299-305.
27. Mollen RM, Hopman WP, Kuipers HH, et al. Abnormalities of upper gut motility in patients with slow-transit constipation. Eur J Gastroenterol Hepatol. 1999;11:701-708.
28. de' Angelis GL, Fornaroli F, de'Angelis N, et al. Wireless capsule endoscopy for pediatric small-bowel diseases. Am J Gastroenterol. 2007;102:1749-1757.
29. Waller SL. Differential measurement of small and large bowel transit times in constipation and diarrhea: a new approach. Gut. 1975;16:372-378.
30. Holdstock DJ, Misiewicz JJ, Smith T. Propulsion (mass movements) in the human colon and its relationship to meals and somatic activity. Gut. 1970;11:91-99.
31. Rao SC, Paulson J, Kuo B, et al. Relationship between the colonic transit of wireless capsule and radio opaque markers in constipation. Am J Gastroenterol. 2008;103:S475.
32. Nyam DC, Pemberton JH, Ilstrup DM. Long-term results of surgery for chronic constipation. Dis Colon Rectum. 1997;40:273-279.
|
Language: | English.
|
Document Type: | Original article-alimentary tract.
|
ISSN: | 1542-3565
|
DOI Number: | https://dx.doi.org/10.1016/j.cgh...- ouverture dans une nouvelle fenêtre
|
Annotation(s) | |
|
|