491 Wireless Motility Capsule Testing Results in New Diagnostic Information in 38% of Patients With Suspected GI Dysmotility: A 6-Year Review

Abstract

INTRODUCTION: GI motility disturbances often present with upper and lower GI symptoms or a combination of both. Wireless Motility Capsule (WMC) is a standardized pH based test that can measure regional and whole gut actual transit times. Aims: 1. Determine the prevalence of transit time abnormalities in patients with GI dysmotility symptoms. 2. Correlate regional transit abnormality with clinical symptoms. 3. Assess change in patients' diagnosis based on WMC testing. METHODS: A prospective study of patients with suspected GI dysmotility who underwent WMC testing between 2012 and 2018. Patients were placed into three groups: 1) Upper GI symptoms: nausea, vomiting, bloating, and abdominal pain. 2) Lower GI symptoms: constipation and diarrhea. 3) Both upper and lower GI symptoms. Assessments of gastric emptying time (GET), small bowel transit time (SBTT), and colonic transit time (CTT) were recorded in each group and the diagnostic yield was evaluated. RESULTS: 72 patients were evaluated with WMC. 59 patients had complete study data and were included in the analysis. Mean age was 46 ± 14 years. 62 (86 %) were female. 21 (29%) had a h/o cancer. 22 (31%) were diabetic. 43/59 (73%) patients had an abnormal WMC result (Table 1). In patients with upper GI symptoms (n = 31), 15 (48%) had delayed GET (Table 2). New diagnostic information was obtained in 14/31 (45%). Of the 13 patients with lower GI symptoms, only 3 (23%) had a prolonged CTT. No patients had isolated abnormality of GET or SBTT. New diagnostic information was obtained in 5/13 (38%). In the group with overlapping upper and lower GI symptoms, only 2 (13%) had multiregional dysmotility. 8/15 (53%) patients had normal transit studies. This resulted in 5 patients (33%) with new diagnostic information. CONCLUSION: GI symptoms are not an accurate predictor of disease localization. Only15 (48%) of the patients with upper GI symptoms had gastroparesis, and 3 (23%) of the patients with lower GI symptoms had slow transit constipation. WMC study resulted in new diagnostic information in 45% of patients with upper GI symptoms, 38% of patients with lower GI symptoms and 33 % of patients with pan GI symptoms, including the presence of isolated and whole gut dysmotility that was not suspected based on the patient's presentation. Therefore patients with suspected GI dysmotility should undergo tests of the entire GI tract, as reported symptoms are poor indicators of the affected gut region.