Abstract

Small intestinal function is critical to digestive health and patients believe an abnormal reaction to food is responsible for many of their symptoms. Despite this, our ability to assess disturbed function in clinical practice has been limited, particularly after ingestion of the complex nutrients which make up normal food. Recent advances in both wireless capsules and magnetic resonance imaging have provided new insights. This review will briefly describe the limitations of past techniques and focus on how these newer techniques are changing our understanding, particularly of how patients' gastrointestinal tracts respond to food.

Highlights

  • Our understanding of functional gastrointestinal diseases is limited by our ability to assess function and nowhere it that better illustrated than in the small bowel

  • Small intestinal function is critical to digestive health and patients believe an abnormal reaction to food is responsible for many of their symptoms

  • Our ability to assess disturbed function in clinical practice has been limited, after ingestion of the complex nutrients which make up normal food

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Summary

Introduction

Our understanding of functional gastrointestinal diseases is limited by our ability to assess function and nowhere it that better illustrated than in the small bowel. Despite this being a vital organ its inaccessibility has markedly limited studies, of how we process complex meals. The stimulus for this review has been a burgeoning of new data derived from a range of novel patient acceptable ways of assessing function. The focus of this review will be on new methods especially MRI which have opened up the area, allowing the study of responses to complex mixed nutrient meals and in both healthy volunteers and patients. While barium contrast radiology gives excellent definition of anatomy it is a poor way of assessing function as the barium suspension used lacks normal nutrients

Intestinal perfusion techniques
Breath tests to evaluate mucosal function and transit
Lactose breath hydrogen test
Xylose breath test
Lactulose breath test to measure transit
Scintigraphic assessment of small bowel transit
Assessment of abnormalities of microbiota in small intestine
Glucose breath hydrogen test
Assessing gas in the small bowel
Wireless capsule telemetry
Endoluminal image analysis to assess small bowel motility
Magnetic tracking System
Magnetic Resonance Imaging of small bowel water
Measuring small bowel water content
Osmotic effect of poorly absorbed solutes
Assessment of digestion of complex foods
Gastrointestinal response to FODMAPs
Impact of dietary fibre on small bowel contents
Effect of phytochemicals
Abnormalities of small bowel in coeliac disease and scleroderma
Abnormalities of small bowel in IBS
Effect of therapeutic interventions
Assessment of small bowel and colonic motility using MRI
Findings
Future studies
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