Gastric Transit Time Research Articles

Deep Learning-Based Real-Time Organ Localization and Transit Time Estimation in Wireless Capsule Endoscopy.

Wireless capsule endoscopy (WCE) has significantly advanced the diagnosis of gastrointestinal (GI) diseases by allowing for the non-invasive visualization of the entire small intestine. However, machine learning-based methods for organ classification in WCE often rely on color information, leading to decreased performance when obstacles such as food debris are present. This study proposes a novel model that integrates convolutional neural networks (CNNs) and long short-term memory (LSTM) networks to analyze multiple frames and incorporate temporal information, ensuring that it performs well even when visual information is limited. We collected data from 126 patients using PillCam™ SB3 (Medtronic, Minneapolis, MN, USA), which comprised 2,395,932 images. Our deep learning model was trained to identify organs (stomach, small intestine, and colon) using data from 44 training and 10 validation cases. We applied calibration using a Gaussian filter to enhance the accuracy of detecting organ boundaries. Additionally, we estimated the transit time of the capsule in the gastric and small intestine regions using a combination of a convolutional neural network (CNN) and a long short-term memory (LSTM) designed to be aware of the sequence information of continuous videos. Finally, we evaluated the model's performance using WCE videos from 72 patients. Our model demonstrated high performance in organ classification, achieving an accuracy, sensitivity, and specificity of over 95% for each organ (stomach, small intestine, and colon), with an overall accuracy and F1-score of 97.1%. The Matthews Correlation Coefficient (MCC) and Geometric Mean (G-mean) were used to evaluate the model's performance on imbalanced datasets, achieving MCC values of 0.93 for the stomach, 0.91 for the small intestine, and 0.94 for the colon, and G-mean values of 0.96 for the stomach, 0.95 for the small intestine, and 0.97 for the colon. Regarding the estimation of gastric and small intestine transit times, the mean time differences between the model predictions and ground truth were 4.3 ± 9.7 min for the stomach and 24.7 ± 33.8 min for the small intestine. Notably, the model's predictions for gastric transit times were within 15 min of the ground truth for 95.8% of the test dataset (69 out of 72 cases). The proposed model shows overall superior performance compared to a model using only CNN. The combination of CNN and LSTM proves to be both accurate and clinically effective for organ classification and transit time estimation in WCE. Our model's ability to integrate temporal information allows it to maintain high performance even in challenging conditions where color information alone is insufficient. Including MCC and G-mean metrics further validates the robustness of our approach in handling imbalanced datasets. These findings suggest that the proposed method can significantly improve the diagnostic accuracy and efficiency of WCE, making it a valuable tool in clinical practice for diagnosing and managing GI diseases.

Comparison of Gas-sensing Capsule With Wireless Motility Capsule in Motility Disorder Patients.

Motility disorders are prevalent, often leading to disrupted regional or whole gut transit times. In this study, we conducted a comparative analysis between the wireless motility capsule and an innovative gas-sensing capsule to evaluate regional and whole gut transit times in individuals with diagnosed motility disorders. We prospectively enrolled 48 patients (34 women) diagnosed with functional dyspepsia and/or functional constipation according to Rome IV criteria. Patients ingested the capsules in tandem. We assessed the agreement between transit times recorded by both devices using Spearman correlation and Bland-Altman analysis. Additionally, diagnostic concordance between the capsules were evaluated using confusion matrices. We observed a significant correlation between the wireless motility capsule and the gas-sensing capsule for gastric emptying time (r = 0.79, P < 0.001) and colonic transit time (r = 0.66, P < 0.001). The gas-sensing capsule exhibited a sensitivity of 0.83, specificity of 0.96, and accuracy of 0.94 when using the standard cutoff for delayed gastric emptying (5 hours). Similarly, when applying the cutoff value for delayed colonic transit (> 59 hours), the gas-sensing capsule demonstrated a sensitivity of 0.79, specificity of 0.84, and accuracy of 0.82. Importantly, the gas-sensing capsule was well-tolerated, and no serious adverse events were reported during the study. Our findings underscore the gas-sensing capsule's suitability as a dependable tool for assessing regional and whole gut transit times. It represents a promising alternative to the wireless motility capsule for evaluating patients with suspected motility disorders.

Clinical and demographic features of patients undergoing video-capsule endoscopy management: A descriptive study.

Video-capsule endoscopy (VCE) is an efficient tool that has proven to be highly useful in approaching several gastrointestinal diseases. VCE was implemented in Colombia in 2003, however current characterization of patients undergoing VCE in Colombia is limited, and mainly comes from two investigations conducted before the SARS-CoV-2 pandemic period. To describe the characteristics of patients undergoing VCEs and establish the main indications, findings, technical limitations, and other outstanding features. A descriptive study was carried out using data from reports of VCE (PillCam SB3 system) use in a Gastroenterology Unit in Bogotá, Colombia between September 2019 and January 2023. Demographic and clinical variables such as indication for the VCE, gastric and small bowel transit times (GTT, SBTT), endoscopic preparation quality, and limitations were described [n (%), median (IQR)]. A total of 133 VCE reports were analyzed. Most were in men with a median age of 70 years. The majority had good preparation (96.2%), and there were technical limitations in 15.8% of cases. The main indications were unexplained anemia (91%) or occult bleeding (23.3%). The median GTT and SBTT were 14 and 30 minutes, respectively. The frequencies of bleeding stigma (3.79%) and active bleeding (9.09%) were low, and the most frequent abnormal findings were red spots (28.3%), erosions (17.6%), and vascular ectasias (12.5%). VCE showed high-level safety. The main indication was unexplained anemia. Active bleeding was the most frequent finding. Combined with artificial intelligence, VCE can improve diagnostic precision and targeted therapeutic interventions.

Glucagon-like peptide-1 receptor agonists and capsule endoscopy in patients with diabetes: a matched cohort study

Background and AimsVideo capsule endoscopy (VCE) is valuable for assessing conditions like gastrointestinal bleeding, anemia, and inflammatory bowel disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are prescribed for diabetes and weight loss, with their pharmacologic effects including delaying gastric emptying. This study investigates the impact of GLP-1 RA usage on VCE outcomes in patients with diabetes. MethodsThis retrospective cohort study involves patients with diabetes undergoing VCE while on GLP-1 RA, matched 1:1 ratio with controls based on demographics and diabetes related factors, who are not on GLP-RA. The primary outcome is gastric transit time in VCE studies, with secondary outcome being incomplete small bowel evaluation and the small bowel transit time. ResultsIn the 68 GLP-1 RA patient cohort, five (7%) experienced VCE failure to pass through the stomach, while all controls passed successfully (p=0.06). GLP-1 RA patients had longer gastric transit time (99.3 ± 134.2 minutes) compared to controls (25.3 ± 31.6 minutes, p <0.001). Multivariate analysis revealed GLP-1 RA usage was associated with increased gastric transit time by 74.5 minutes (CI: 33.8-115.2, p <0.001) compared to controls, after adjusting on relevant factors. Sixteen GLP-1 RA patients (23.5%) experienced incomplete passage of the VCE through the small intestine, a significantly higher rate compared to three patients in the control group (4.4%) (p<0.01). ConclusionsGLP-1 RA usage is associated with prolonged gastric transit time and a higher rate of incomplete small bowel evaluation during VCE. Future studies may be crucial for evaluating strategies to mitigate these effects.

Incomplete small bowel capsule endoscopy: Risk factors and cost-effectiveness of real-time viewing.

Background and study aims International guidelines recommend real-time viewing (RTV) in capsule endoscopy for gastric emptying monitoring, yet it is often overlooked in clinical practice. We aimed to assess risk factors for incomplete small bowel capsule endoscopy (SBCE) and evaluate the clinical relevance and cost-effectiveness of RTV implementation. Methods We included consecutive SBCEs from 2013 to 2020. RTV was not applied per local protocol. We used multivariate logistic regression to identify risk factors for incomplete SBCE, including prolonged gastric transit time (GTT) and prolonged small bowel transit time (SBTT). Results Analyzing 858 SBCEs, we observed a completion rate of 94.6%. Prolonged GTT and SBTT were present in 4.9% and 18.2% of complete SBCEs, and in 13% ( P =0.03) and 10.8% ( P =0.24) of incomplete SBCEs, respectively. Only 0.7% (6 of 858) had incomplete SBCE with prolonged GTT. In both univariate and multivariate analysis, a modifiable (prolonged GTT odds ratio [OR] 2.9; 95% confidence interval [CI] 1.1-7.5) and two unmodifiable risk factors (inpatient status OR 2.3; 95% CI 1.1-4.5) and history of incomplete SBCE (OR 4.2; 95% CI 1.3-13.7) were independently linked to higher incomplete SBCE rates. The pretest completion probability was 90.5% and 95.8% in patients with and without unmodifiable risk factors, respectively ( P <0.01). The direct cost of systematic RTV adoption and prokinetics administration would be €5059, aiming to identify and treat each case of prolonged GTT associated with incomplete SBCE. Conclusions Modern devices make incomplete SBCE rare, usually not tied to prolonged GTT. In a low-incidence scenario, widespread RTV use brings high costs and uncertain effectiveness.

Effect of a Gluten-Free Diet on Whole Gut Transit Time in Celiac Disease (CD) and Non-Celiac Gluten Sensitivity (NCGS) Patients: A Study Using the Wireless Motility Capsule (WMC).

Background: This study explores the impact of a gluten-free diet (GFD) on regional gastrointestinal (GI) transit times in individuals with celiac disease (CD) and non-celiac gluten sensitivity (NCGS). While a GFD is established for managing CD and wheat allergy, its effects on NCGS remain controversial due to inconclusive evidence. Methods: Utilizing a wireless motility and pH capsule (WMC) to assess regional (measurements of gastric, small bowel, and colonic transit times) and whole gut transit, newly diagnosed CD (n = 12) and NCGS (n = 12) patients underwent evaluations at baseline and 4 weeks after having a GFD. Results: At baseline conditions, individuals diagnosed with CD exhibited prolonged colonic and intestinal transit times when compared to those with NCGS (p < 0.05). Following a 4-week GFD, CD patients experienced significant reductions in both intestinal and colonic transit times, along with enhanced small intestine contractility. NCGS individuals showed improvements in intestinal transit time and contractility with a GFD, although the colon exhibited no discernible effect. The GFD did not significantly impact intragastric, intestinal, or colonic pH. Conclusions: This study, employing WMC for the first time, provides novel insights into the positive effects of a GFD on intestinal and colonic transit, as well as contractility, in CD patients, and to a lesser extent, in those with NCGS.

The Potential of Polysaccharides from Various Plants as Constipation Treatment

Constipation is one of the disorders of Irritable Bowel Syndrome (IBS). Lack of consumption of water and food with fiber are some of the causes of constipation. Treatment for constipation patients can be solved by administering laxatives through drugs (pharmaceuticals) or using polysaccharide parts from plants. There are at least three types of laxatives: bulking agents (having the ability to bulk up), osmotic agents, and stimulants. Polysaccharides can be sourced from whole or some parts of the plants. Each type of plant has different polysaccharide components, and their effects on constipation treatment are also specific. The study aimed to review the mechanisms of polysaccharides from various plants parts and explained the misconception of polysaccharide intake as a laxative agent in treating constipation. This review was based on literature studies related to polysaccharides from plants materials and their effects as laxatives in experimental animals. The review found that these polysaccharides have a positive effect as a laxative or digestive aid. In general, polysaccharides from several plants were extracted and characterized to be used as anti-constipation test materials. These polysaccharides can help increase the amount, weight, and water content of feces (bulk), increase peristalsis, speed up gastric emptying and transit time, as well as restore hormones that work in movement in the digestive tract, and improve the condition of the distal colon tissue. These studies are still limited to using animals as experimental test material in polysaccharides to treat constipation. In addition, it has the potential to be further explored regarding the possibility of clinical trials of polysaccharides in humans as laxatives.

Adult and pediatric physiologically-based biopharmaceutics modeling to explain lamotrigine immediate release absorption process.

Physiologically-based biopharmaceutics modeling (PBBM) has potential to accelerate the development of new drug and formulations. An important application of PBBM is for special populations such as pediatrics that have pharmacokinetics dependent on the maturation process. Lamotrigine (LTG) is a Biopharmaceutics Classification System (BCS) II drug and is widely prescribed. Therefore, the goal of this study was to assess the biopharmaceutics risk of the low-soluble drug LTG when the ontogeny on gastrointestinal tract (GIT) physiological parameters are considered. An oral physiologically-based pharmacokinetic model and a PBBM were developed and verified using GastroPlus™ software for both adults and children (2-12 years old, 12-52 kg). The biopharmaceutics properties and GIT physiological parameters were evaluated by sensitivity analysis. High doses were simulated assuming a worst case scenario, that is, the dose of 200 mg for adults and 5 mg/kg (up to the maximum of 200 mg) for 2-year-old children. Although several authors have suggested that ontogeny may have an effect on gastrointestinal fluid volume, our study found no evidence of interference between fluid and dose volumes with invivo dissolution of LTG. The most impactful parameter was found to be the gastric transit time. Therefore, the hypothesis is developed to examine whether LTG exhibits characteristics of a BCS II classification invitro while showing BCS I-like behavior invivo. This hypothesis could act as a base for conducting novel studies on model-informed precision dosing, tailored to specific populations and clinical conditions. In addition, it could be instrumental in assessing the influence of various release profiles on invivo performance for both adult and pediatric populations.

The Association Between Acidification Time on Wireless Motility Capsule and Gastroesophageal Reflux Disease.

Gastric physiological characteristics such as fundus accommodation, gastric distention, emptying/transit time, and basal acid output may contribute to the pathogenesis of gastroesophageal reflux disease (GERD). Wireless motility capsule (WMC) uses pH data to determine gastric transit time but has not been used in the evaluation of GERD. Certain metrics such as acidification time, nadir pH, and gastric transit time may provide insight into the mechanisms of GERD related to gastric physiology, allowing WMC to be a complementary tool in the diagnosis of GERD. We aimed to determine whether pH data and transit time on WMC tests correlated with the presence of GERD on ambulatory reflux testing. This was a retrospective study of 28 patients who had undergone both WMC and reflux testing via wireless pH or pH/impedance. Acidification time (time from capsule ingestion to pH<2), nadir postprandial pH, and gastric transit time were manually determined from the WMC capsule proprietary software. Spearman correlation was used to compare these metrics with gastric transit time, percent esophageal acid exposure, and DeMeester score. Acidification time moderately correlated with gastric transit time, R: 0.44, P=0.02, but not nadir pH, percent esophageal acid exposure, or DeMeester score. Patients with an abnormal reflux test had a significantly longer median acidification time (135.5 vs. 78.5min, P=0.021). After stratifying by patients with normal versus prolonged gastric transit time, there was a trend toward longer acidification time in patients with positive reflux testing in both groups, but this was not statistically significant. Patients with prolonged gastric transit time >300 minutes were not more likely to have a positive reflux test (38% vs. 35%, P=1). The acidification time on WMC was significantly longer in patients with proven GERD and acidification time positively correlated with gastric transit time. Larger studies are needed to determine whether WMC could be used as a complementary tool in investigating patients with GERD symptoms.

An Insight on Novel Approaches & Perspectives for Gastro-Retentive Drug Delivery Systems.

The conventional oral drug delivery systems face a lot of difficulties in the gastrointestinal tract, such as inappropriate drug release and reduction in the efficacy of the doses, which makes this system less susceptible to the delivery of drug formulation. For the enhancement of therapeutic efficacy and bioavailability of the drug, many efforts have been made. The drug candidates which are not stable at alkaline pH and soluble in acidic medium were selected to increase their therapeutic effectiveness through gastro retentive drug delivery systems (GRDDS). This article discusses various factors which alter the gastro retention time (GRT) of the gastro retentive drug delivery system in the stomach and intestine (duodenum). It emphasizes on the novel approaches made for the delivery and release of drugs with the use of magnetic systems, floating (low-density) systems, super porous hydrogels, raft systems, mucoadhesive systems, high-density systems and expandable systems. Along with the applications, the key aspects of in vivo, in vitro & clinical studies in different approaches to GRDDS have been addressed. In addition, future perspectives have been summarized to reduce gastric transit time in fasting and fed conditions.

Associations Between Physical Activity and Gastrointestinal Transit Times in People with Normal Weight, Overweight, and Obesity

BackgroundRapid gastric emptying is associated with obesity and overeating, whereas delayed gastric emptying is associated with anorexia. Acute effects of exercise on gastric emptying have been investigated extensively, but the influence of habitual physical activity on gastric emptying and transit time in other regions of the gastrointestinal tract is poorly understood. ObjectiveThe objective was to investigate associations between objectively measured habitual physical activity and gastrointestinal transit times in adults with varying degrees of adiposity. Methods50 adults (58% women) were included in this cross-sectional study. Physical activity was measured by an accelerometer placed on the lower back for 7 d. Gastric emptying time, small bowel transit time, colonic transit time, and whole gut transit time were simultaneously evaluated by a wireless motility capsule, which was ingested together with a standardized mixed meal. Linear regression models were applied to assess the associations of total activity counts and time spent at different intensities—sedentary activity (0–100 counts/min), low light activity (101–759 counts/min), high light activity (760–1951 counts/min); moderate and vigorous activity (≥1952 counts/min)) with gastrointestinal transit times. ResultsMedian [Q1; Q3] age was 56.5 [46.6–65.5] y, and body mass index (BMI) was 32.1 [28.5–35.1] kg/m2. For every additional hour spent performing high light intensity physical activity, colonic transit time was 25.5 % [95% CI: 3.10, 42.7] more rapid (P = 0.028), and whole gut transit time was 16.2 % [95% CI: 1.84, 28.4] more rapid (P = 0.028) when adjusted for sex, age, and body fat. No other associations were observed. ConclusionsMore time spent on physical activity at high light intensity was associated with more rapid colonic and whole gut transit time, independent of age, sex, and body fat, whereas other intensities of physical activity and gastrointestinal transit times were not associated. Trial registrationClinicaltrials.gov IDs (NCT03894670, NCT03854656).

Physiologically Based Pharmacokinetic Model Development and Verification for Bioequivalence Testing of Bempedoic Acid Oral Suspension and Reference Tablet Formulation.

The bioequivalence of bempedoic acid oral suspension and commercial immediate release (IR) tablet formulations were assessed using a physiologically based pharmacokinetic (PBPK) model. The mechanistic model, developed from clinical mass balance results and in vitro intrinsic solubility, permeability, and dissolution data, was verified against observed clinical pharmacokinetics (PK) results. Model inputs included a fraction of a dose in solution (0.01%), viscosity (118.8 cps), and median particle diameter (50 µm) for the suspension and particle diameter (36.4 µm) for IR tablets. Dissolution was determined in the relevant media (pH 1.2-6.8) in vitro. Model simulations of bioequivalence predicted oral suspension (test) to IR tablet (reference) geometric mean ratio estimates of 96.9% (90% confidence interval [CI]: 92.6-101) for maximum concentration and 98.2% (90% CI: 87.3-111) for the area under the concentration-time curve. Sensitivity analyses showed gastric transit time had a minor impact on model predictions. Oral suspension biopharmaceutical safe space was defined by extremes of particle size and the percent of bempedoic acid in solution. PBPK model simulations predicted that the rate and extent of bempedoic acid absorption are unlikely to exhibit clinically meaningful differences when dosed as an oral suspension compared with an IR tablet without requiring a clinical bioequivalence study in adults.

Magnetic-Assisted Capsule Endoscopy in Children With Crohn Disease: Feasibility and Impact on Gastric Transit Time.

Standard capsule endoscopy (CE) is ineffective for upper gastrointestinal (GI) tract examination because it does not allow operator-controlled navigation of the capsule. Magnetically assisted capsule endoscopy (MACE) may offer a solution to these problems. This pilot study is aimed to evaluate the feasibility of MACE system in pediatric Crohn disease (CD) and if magnetic steering could enhance capsule gastric emptying when compared with standard CE. Pediatric CD patients already studied by standard small bowel CE were enrolled. All participants swallowed a magnetically assisted CE and an external magnetic field navigator was used to guide the capsule through the upper GI tract. Maneuverability, completeness of the MACE examination, differences in the esophageal transit time (ETT), gastric transit time (GTT), and pyloric transit time (PTT) between standard CE and MACE were assessed. Ten patients [mean age 11.4 years (range 6-15); 60% male] were enrolled. Maneuverability was defined as good and fair in 60% and 40% of participants, respectively. Completeness of MACE examination was 95%, 65%, and 92.5% in the esophagus, proximal, and distal stomach, respectively. Transpyloric passage of the capsule under magnetic control was successfully performed in 80% of patients. Magnetic intervention significantly increased ETT ( P < 0.001) and reduced GTT and PTT ( P = 0.002). No significant adverse events occurred. MACE is a safe and feasible technique in children. Magnetic steering enhances capsule gastric emptying and facilitates capsule transpyloric passage when compared with standard CE.

BARIUM SULFATE GELATIN AS A NOVEL APPROACH TO FACILITATE GASTROINTESTINAL TRACT POSITIVE CONTRAST STUDIES IN A CAPTIVE HARBOR SEAL (PHOCA VITULINA) AND CALIFORNIA SEA LIONS (ZALOPHUS CALIFORNIANUS) WITHOUT RESTRAINT.

Gastrointestinal tract contrast medium studies are a valuable diagnostic modality to evaluate gastrointestinal anatomy, motility, and pathology. Four positive contrast medium studies were performed twice on a harbor seal (Phoca vitulina) and once each on two California sea lions (Zalophus californianus) to evaluate for gastrointestinal abnormalities by using barium-impregnated gelatin. Because marine mammals in human care routinely receive plain gelatin as a component of their diet and as secondary reinforcement, feeding a barium gelatin mitigates the need for tube feeding or restraint. Operant conditioning was used to position the pinnipeds for voluntary radiographs. The barium gelatin permitted adequate evaluation of gastric emptying and intestinal transit times and good evaluation of the structure of the intestinal tract. Full evaluation of gastric anatomy was limited due to the gelatin blocks not conforming to the stomach in their solid form and the barium quickly exiting the stomach as barium gelatin blocks disintegrated and because orthogonal views could not always be acquired. Even with these limitations, barium gelatin resulted in diagnostically valuable contrast imaging in a stress-free patient setting with reduced risk of aspiration and eliminated the effects that anesthesia can have on gastric motility as well as other anesthesia-associated risks.

Stepping it up: Physical activity is associated with a lower incidence of prolonged gastric transit time in capsule endoscopy.

Physical activity has been proposed as a potential factor influencing capsule endoscopy (CE) gastric transit time (GTT). However, there is no reported factual evidence confirming this association. We aimed to prospectively assess the effect of physical activity in the first hour of CE in the occurrence of prolonged GTT. This is a prospective study including consecutive patients undergoing CE. For each patient, a step counter was attached to the CE register. The number of steps during the first hour of the procedure was registered. The main outcome was prolonged GTT (CE remaining in the stomach for >1h). Outcomes were adjusted for possible confounders by multivariate analysis. We included 100 patients, 60% undergoing small bowel CE and 40% colon CE. The mean number of steps in the first hour was significantly lower in patients with prolonged GTT (2009±1578 steps) comparatively with those without prolonged GTT (3597±1889 steps) (P<0.001). On multivariate analysis including significant confounders, steps in the first hour were an independent predictor of prolonged GTT (P=0.018). Single-handedly, the number of steps taken in the first hour had a good acuity for predicting prolonged GTT (area under the curve=0.74; P<0.001), with an optimal cut-off of 2000 steps (sensitivity 81.3% and specificity 70%). Physical activity during the first hour of CE significantly decreased the occurrence of prolonged GTT. These findings pave the way for further definition of clear instructions to give to patients undergoing CE.

Floating Drug Delivery System: A Novel apporach for Delivery of Drug on Targated Organ

The goal of this review on floating drug delivery systems (FDDS) was to compile latest data with a particular focus on the main mechanism of flotation for stomach retention. Drug delivery systems that float instantly when they come into contact with gastric fluids are promising approaches for increasing the bioavailability of drugs within absorption window in the stomach or upper small intestine. They are unstable in the intestinal or colonic environment and have low solubility at high pH values. The Current pharmaceutical scenario focuses on the development of sustained drug delivery systems to achieve required therapeutic concentration with less amount of dose. Oral delivery of the drug is the preferable drug delivery system. Because of the ease of administration, patient compliance and formulation flexibility. The ability to delay and control the emptying period of a dosage form in the stomach is an extremely variable process. For dosage forms that stay in the stomach for longer periods of time than standard dosage forms so the gastric transit time is a valuable asset for this system. The goal of this review article is to provide detailed information on the pharmaceutical basis of their design, classification, advantages, in vitro and in vivo evaluation parameters, and applications of floating systems. These systems can help with a variety of issues that arise during the development of a pharmaceutical dosage form, as well as the potential of FDDS in the future. This review article makes an attempt to introduce readers to current developments in floating drug delivery systems.

Naringenin modulates Cobalt activities on gut motility through mechanosensors and serotonin signalling

Introduction Cobalt chloride-(CoCl2) exerts beneficial and toxic activities depending on dose however Naringenin-(Nar) a flavonoid, chelates heavy metals. Absorption of ingested heavy metals, or chelates are dependent on gut motility (gastric emptying and intestinal transit time) and mechanosensor regulation. Literature is vague on CoCl2 activities on gut motility and mechanosensor nor probable chelating actions with naringenin which was investigated in this study. Method One hundred male Wistar rats were grouped viz; A to D (25, 62, 150 and 300 mg/kg CoCl2), E to H doses of CoCl2+Nar (50 mg/kg), I-Narigenin and J-Control. Gastric emptying and intestinal transit time were evaluated by day eight, intestinal tissue assayed for biochemical, histological and immunohistochemistry reactivity. Result CoCl2 significantly increased Gastric emptying (150 and 300 mg/kg) and Intestinal transit time unlike Naringenin. CoCl2 (150 mg/kg) significantly increased Catalase and Nitric oxide but ameliorated by Naringenin. ATPase activities significantly increased in 150 mg/kg-CoCl2 but ameliorated by Naringenin. Carbonyl levels increased in all CoCl2+Nar groups. High Enterochromaffin-cell count in 25 and 62 mg/kg-CoCl2 were ameliorated by Naringenin. Serotonin immunoreactivity increased in CoCl2 (25, 62, 300 mg/kg) but reduced in CoCl2+Nar groups. Conclusion Cobalt chloride enhanced gastric motility via increased mechanosensor activities and serotonin expression at low doses. Naringenin ameliorated toxicity of high cobalt chloride via metal-flavonoid chelates.

Preparation of small bowel capsule endoscopy (SBCE) with simethicone: A meta-analysis

BackgroundIt is disputed about optimal bowel preparation for small bowel capsule endoscopy (SBCE). This meta-analysis aimed to investigate the role of simethicone in intestinal preparation for SBCE. MethodsWe searched four databases (PubMed, web of science, Embase, and Scopus databases) for relevant studies. Studies evaluating the effect of simethicone as an adjunct to SBCE bowel preparation were included. The random-effects model was applied to calculate the risk estimates. Primary outcomes include the degree of gas bubbles and small bowel visualization quality (SBVQ). Secondary outcomes include diagnostic yield (DY), gastric transit time (GTT), small bowel transit time (SBTT), and completion rate (CR). ResultsA total of 10 studies were included (8 RCTs, 1 prospective, and 1 retrospective study). Compared with the control group, the simethicone group showed significant improvements in the degree of gas bubbling (RR = 2.05, 95%CI:1.56-2.71, P < 0.001, I2 = 62%) and SBVQ (RR = 1.41, 95%CI: 1.20-1.65, P < 0.001, I2 = 16%). Subgroup analysis showed that the SBVQ of simethicone group was better than fasting (RR = 2.62, 95% CI:1.49–4.59, P < 0.001, I2 = 0%), mannitol (RR = 1.35, 95% CI: 1.14-1.59, P < 0.001, I2 = 0%) and PEG group (RR = 1.32, 95%CI:1.06-1.65, P = 0.01, I2 = 0%). No significant associations were found for DY, GTT, SBTT, and CR. ConclusionsSimethicone for bowel preparation is useful to improve visualization and reduce the gas bubbling of SBCE.

Formulation and Characterization of Expandable Tablet of Diacerein using Swellable Polymers

Some of the drugs have poor absorption because of a narrow absorption window in the gastrointestinal tract (GIT). To improve the absorption of such drugs in the GIT, gastro-retentive drug delivery techniques play an important role. Diacerein is an antirheumatic drug used for joint pain and arthritis. The expandable gastro-retentive tablets were prepared to attain an extended therapeutic action of Diacerein. Expandable tablets were formulated to prolong gastric retention, enhance the bioavailability of the drug candidate and attain a desirable size greater than the diametric size of the pyloric sphincter (i.e., 13 mm in diameter) of the tablet after administration by expandable technique. The expandable tablet was formulated using swellable polymers and polyelectrolytes, i.e., HPMCK 100, PEO, chitosan, and carbopol. The proposed expandable tablets were evaluated by preliminary evaluation parameters, micromeritic investigations, all physicochemical evaluations including swelling index, weight variation, drug content, in-vitro release studies and their release kinetics. Method: The wet granulation method is used for the preparation of expandable tablets of Diacerein. Result: The release of Diacerein from all formulations was studied in phosphate buffer pH 1.2 at 37±5°C. The net results conclude that the formulation having HPMC K 100, PEO with the addition of carbopol (formulation C1) showed the maximum swelling index as compared to others. And it was found that formulation C1 is the most superior and reliable formulation in terms of all physicochemical parameters and in-vitro drug release studies. The best formulation obtained from in-vitro drug release studies was shown.&#x0D; Keywords: Gastro retentive, expandable system, noval drug delivery system, controlled drug delivery system, gastric transit time, swellable polymers, GIT.

A Short Review on Floating Drug Delivery System

In the latest years, scientific and technical progresses have been made in the study and progress of novel drug delivery systems by overcoming physiological difficulties such as short gastric residence times and unpredictable gastric emptying times. Gastric emptying of dose form is extremely variable process and ability to prolong and control the emptying time. Gastric transit time is valuable asset for dosage forms, which reside in the stomach for a long period of time than conventional dosage form. Several approaches are currently utilized in the prolongation of the gastric residence times, including floating drug delivery systems, swelling and expanding systems, polymeric bioadhesive systems, modified-shape systems, high-density systems and other delayed gastric emptying devices. The purpose of writing this review on floating drug delivery systems (FDDS) was to compile the recent literature with special focus on the principal mechanism of floatation to achieve gastric retention. This review explains briefly about types of floating system, advantages, limitation, floating mechanism, factors affecting floating system, drug candidates suitable for floating, evaluation parameters and application of the system.