Impact of Wireless Motility Capsule Testing on Management Strategies and Symptomatic Improvement in Diabetic Patients with Gastrointestinal Dysmotility

Abstract

Introduction: Wireless Motility Capsule (WMC) is used for the assessment of diabetic (DM) patients with suspected gastrointestinal (GI) dysmotility. However, the impact of WMC findings on the clinical management and subsequent symptomatic improvement is not clearly understood. Our aim was to assess the change in therapy and resulting change in symptoms based on WMC testing in DM patients with suspected GI dysmotility. Methods: Retrospective chart review of all DM patients who had WMC testing at our institution from 2010 to 2015 was performed. Only patients for whom follow-up information was available regarding medication changes and response to treatment were included. Patients with a previous history of gut surgery, inflammatory bowel disease or gut cancer were excluded. Results of WMC testing were classified as isolated vs. multiregional dysmotility. The presenting symptoms, change in treatment after WMC testing and symptom response were noted. Chi-square test for independence was used to compare the extent of involvement on WMC testing in those who responded to therapy. Results: A total of 47 patients were included. Mean age was 46 ± 14 years with 77% being females. The prevalence of presenting symptoms is illustrated in figure 1. Nausea and/or vomiting was the most commonly reported symptom (96%), followed by abdominal pain (74%), constipation (72%), bloating (53%) and diarrhea (32%). Treatment prescribed included: Ondansetron/Promethazine (N=27), Erythromycin (N=20), Metoclopramide (N=26), Domperidone (N=14), Linaclotide (N=14), Polyethylene glycol (N=13), Lubiprostone (N=7) and Mirtazapine (N=4). WMC testing was abnormal in 37 (79%) patients. Among those, treatment changes as a result of WMC testing were made in 25 patients (66%). Overall, 27 (57%) patients reported improvement in at least one symptom (Figure 2). In those patients, the extent of involvement on WMC testing was not significantly different, with 52% having an isolated dysmotility and 48% having multiregional involvement (p=0.9) Response to treatment was highest for Linaclotide (64%) and lowest for Metoclopramide (19%). Response to the rest of the medications is presented in figure 3.Figure 1Figure 2Figure 3Conclusion: WMC testing leads to changes in management in 66% of DM patients with symptoms of GI dysmotility. Symptom improvement was noted in 57% of patients. Isolated vs multiregional pattern of underlying GI dysmotility does not seem to impact symptom improvement. Multiple treatment options are available with varying symptom response.