Does Lubiprostone Decrease Gastric and Small Bowel Transit Time and Improve Visualization of Small Bowel with Capsule Endoscopy?

Abstract

Purpose: Lubiprostone, a selective activator of type 2 chloride channels, is approved for treatment of chronic idiopathic constipation and constipation predominant IBS. It has been suggested that lubiprostone has a prokinetic effect. This investigation was designed to evaluate lubiprostone as a preparation and propulsive agent for small bowel capsule endoscopy. Methods: The PillCam Small Bowel (SB) capsule endoscopy system (Given Imaging, Yoqneam, Israel) utilizing the PillCam SB1 capsule and Rapid 5 software platform was used. The study was designed as a double blinded placebo-control trial in 40 healthy adults to compare gastric transit time (GTT), small bowel transit time (SBTT), and small bowel cleansing preparation. The study subjects received lubiprostone 24 mcg or placebo 30 minutes prior to PillCam capsule ingestion. Capsule endoscopy studies were read by two independent investigators unaware of the study medication received and differences in interpretation were resolved by consensus. Anatomical landmarks were identified and GTT and SBTT were calculated. Overall preparation assessment of the proximal, mid, and distal small bowel was determined by a 4 step scale. Percentage of visualized bowel was determined by review of 10 minute video segments at 1 hr intervals after the capsule passed through the pylorus. Results: In the lubiprostone group (N = 20), 2 subjects did not pass the capsule through the pylorus in the 8 hr battery time of the capsule. An additional 3 capsules did not pass into the colon. In the placebo group (N = 20), all capsules passed into the small bowel, but 1 did not pass into the colon. The subjects in which the capsules did not pass into the small bowel were excluded from the small bowel analysis. In the subjects that the capsules did not reach the colon, the SBTT was determined by total number of minutes subtracted from the gastric emptying time for each subject. The mean GTT in the lubiprostone group was 126 minutes and 43 minutes in the placebo group (P= 0.0095). The mean SBTT in the lubiprostone group was 208 minutes and 228 minutes in the placebo group (P= 0.249). The overall preparation assessment of the small bowel was not statistically significant between the 2 groups in the proximal, mid or distal small bowel (p- = 0.119-proxmial, 0.118-mid, 0.121-distal). There was no significant difference in lubiprostone vs. placebo in the percentage of visualized small bowel. Conclusion: Lubiprostone had a significant increase in GTT but did not result in a significant decrease in SBTT as compared to placebo. The administration of lubiprostone prior to capsule ingestion did not result in improved overall preparation of the small bowel for capsule endoscopy or increase the percentage of visualized small bowel.