Wireless Motility Capsule In Patients Research Articles

Regional Gastrointestinal Transit and Contractility Patterns Vary in Postural Orthostatic Tachycardia Syndrome (POTS)

Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder that affects multiple organs, including the gastrointestinal system. These patients often have multiple GI complaints with a severe impact on their quality of life. GI dysmotility patterns in POTS remains poorly understood and difficult to manage. The aim of this study was to investigate the diagnostic yield of wireless motility capsule in patients with gastrointestinal symptoms and POTS, with use of a symptomatic control group without POTS as a reference. We retrospectively reviewed the charts of patients who had both autonomic testing and wireless motility capsule between 2016 and 2020. The two groups were divided into those with POTS and those without POTS (controls) as diagnosed through autonomic testing. We compared the regional transit times and motility patterns between the two groups using the data collected from wireless motility capsule. A total of 25% of POTS patients had delayed small bowel transit compared to 0% of non-POTS patients (p = 0.047). POTS patients exhibited hypo-contractility patterns within the small bowel, including decreased contractions/min (2.95 vs. 4.22, p = 0.011) and decreased motility index (101.36 vs. 182.11, p = 0.021). In multivariable linear regression analysis, migraine predicted faster small bowel transit (p = 0.007) and presence of POTS predicted slower small bowel transit (p = 0.044). Motility abnormalities among POTS patients seem to affect mostly the small bowel and exhibit a general hypo-contractility pattern. Wireless motility capsule can be a helpful tool in patients with POTS and GI symptoms as it can potentially help guide treatment.

481 Motility Abnormalities Identified by Wireless Motility Capsule in Postural Orthostatic Tachycardia Syndrome

INTRODUCTION: Gastrointestinal symptoms are common in patients with postural tachycardia syndrome (POTS). Previous studies have reported a wide range of abnormalities, particularly delayed gastric emptying in POTS. Wireless motility capsule (WMC) is a minimally invasive test that allows the evaluation of gastrointestinal physiology. We aimed to investigate the diagnostic yield of WMC in patients with POTS. METHODS: We conducted a retrospective review of all patients at our institution with both formal WMC testing (SmartpillTM) and autonomic testing for evaluation of gastrointestinal and neurological symptoms respectively. Patient demographics and results of respective testing were extracted. We compared transit abnormalities and contraction patterns between patients meeting diagnostic criteria for POTS and those without POTS. Transit abnormality percentages were compared using chi2 testing, and contraction pattern parameters were compared using 2-sample t-testing. RESULTS: A total of 27 women with both WMC and autonomic testing were studied. The mean age was 39.6 (range 18-68). Fourteen patients had POTS, while the other 13 had either mild or no autonomic abnormalities. Patients with POTS were more likely to have delayed small bowel transit (42.9% vs 7.69%, P = 0.037), but no differences were seen in gastric or colonic transit delays (Table 1). Additionally, POTS patients were more likely to exhibit a hypocontractile pattern throughout the gastrointestinal tract compared to non-POTS patients. Specifically, maximal gastric pressure, and small bowel peak amplitude and motility index were significantly lower in POTS patients. There was a trend towards lower colonic maximum pressure, contraction/min and peak amplitude in POTS patients that did not reach significance (Table 1). CONCLUSION: Our data shows that gastrointestinal motility abnormalities, as observed in WMC, are more common in patients with POTS. Patients with POTS were more likely to have delayed small bowel transit, as well as hypocontractile gastrointestinal patterns, particularly in the small bowel, compared to non-POTS patients. WMC offers a unique opportunity to evaluate patients with autonomic dysfunction and POTS. Further prospective evaluation and higher sample sizes are needed.

Validation of Diagnostic and Performance Characteristics of the Wireless Motility Capsule in Patients With Suspected Gastroparesis

It is a challenge to make a diagnosis of gastroparesis. There is good agreement in results from wireless motility capsule (WMC) analysis and gastric emptying scintigraphy (GES), but the diagnostic yield of WMC is unclear and the accuracy of this method has not been validated. We compared the performance characteristics of WMC vs GES in assessing gastric emptying in patients with suspected gastroparesis. We performed a prospective study of 167 subjects with gastroparesis (53 with diabetes and 114 without) at 10 centers, from 2013 through 2016. Subjects were assessed simultaneously by GES and with a WMC to measure gastric emptying and regional transit. Delayed gastric emptying by GES was defined as more than 10% meal retention at 4 hrs whereas delayed gastric emptying by WMC was defined as more than 5 hrs for passage of the capsule into the duodenum; a severe delay in gastric emptying was defined as a gastric emptying time of more than 12 hrs by WMC or more than 35% retention at 4 hrs by GES. Rapid gastric emptying was defined as less than 38% meal retention at 1 hr based on by GES or gastric emptying times less than 1:45 hrs by WMC. We compared diagnostic and performance characteristics of GES vs WMC. Delayed gastric emptying was detected in a higher proportion of subjects by WMC (34.6%) than by GES (24.5%) (P=.009). Overall agreement in results between methods was 75.7% (kappa=0.42). In subjects without diabetes, the WMC detected a higher proportion of subjects with delayed gastric emptying (33.3%) than GES (17.1%) (P < .001). A higher proportion of subjects with diabetes had delayed gastric emptying detected by GES (41.7%) compared with non-diabetic subjects (17.1%) (P=.002). Severe delays in gastric emptying were observed in a higher proportion of subjects by WMC (13.8%) than by GES (6.9%) (P = .02). Rapid gastric emptying was detected in a higher proportion of subjects by GES (13.8%) than by WMC (3.3%) (P < .001). Regional and generalized transit abnormalities were observed in 61.8% subjects and only detected by WMC. Although there is agreement in analysis of gastric emptying by GES vs WMC, WMC provides higher diagnostic yield than GES. WMC detects delayed gastric emptying more frequently than GES and identifies extra-gastric transit abnormalities. Diabetic vs non-diabetic subjects have different results from GES vs WMC. These findings could affect management of patients with suspected gastroparesis. ClinicalTrials.gov no: NCT02022826.

Validation of Performance Characteristics of the Wireless Motility Capsule in Patients With Gastroparesis Symptoms

Validation of Performance Characteristics of the Wireless Motility Capsule in Patients With Gastroparesis Symptoms

528 - What is the Diagnostic Utility of Wireless Motility Capsule in Patients with Suspected Gastrointestinal Dysmotility?

528 - What is the Diagnostic Utility of Wireless Motility Capsule in Patients with Suspected Gastrointestinal Dysmotility?

Su1562 - The Safety Profile of Wireless Motility Capsule in Patients with Suspected Multiregional Gastrointestinal Dysmotility

Su1562 - The Safety Profile of Wireless Motility Capsule in Patients with Suspected Multiregional Gastrointestinal Dysmotility

Tu2078 The Effect of Lubiprostone on Regional Alimentary Tract Transit Times Measured by Wireless Motility Capsule in Patients With Chronic Constipation

Introduction: Lubiprostone, a selective type 2 chloride channel (ClC-2) activator, induces a chloride-rich intestinal fluid secretion which diminishes viscoelasticity of luminal contents and increases lubrication. These effects have led to increased stool frequency and relief of symptoms in patients with chronic constipation (CC). While radionuclide studies have indicated acceleration in colon transit, the impact of lubiprostone on transit times in specific regions of the gut has not been clarified. These measurements can now be achieved by the novel wireless motility capsule (WMC) technology in patients with CC. Our aim was to investigate the effects of lubiprostone on gastric emptying (GET), small bowel (SBTT), colon (CTT) and small/large bowel (SLBTT) transit times assessed by WMC in CC (Rome III) patients. Methods: Twenty nine female patients with CC, mean age 38 (19-64) mean weight 167 lbs (111-305) were tested with WMC before treatment and on day number 8 after receiving 24 mcg BID of lubiprostone. GET was calculated from the time WMC was ingested until the point at which there was an abrupt and sustained increase in pH of more than 2 units from the gastric pH to an absolute pH of .6.0. SBTT was defined as the elapsed time from capsule leaving the stomach until capsule arrived at the cecum. This was determined by a sudden drop of pH.1 unit, for longer than 1 h, which was preceded by a gradual, sustained rise in pH as the capsule passes through the distal small bowel. CTT was defined as the time interval between the point of entry into the cecum and the exit of WMC from the body. SLBTT includes SBTT and CTT. Statistical analysis, using Mann-Whitney Rank Sum Test was performed using Sigma-Stat software. Results are presented as Median with 25-75 percentiles range. Results: After administration of lubiprostone gastric emptying was slowed by 14.5% to 4.02h (2.27-8.82) versus 3.51h (2.38-12.83) at baseline (P=0.913); SBTT was significantly accelerated by 12.2% to 4.03h (3.13-4.49) when compared with 4.59 h (4.00-6.32) at baseline (P=0.010) and CTT was accelerated by 10.1% to 35.1h (22.66-47.99) vs 39.05h (22.61-63.39) before treatment ( P=0.328). The comparison of SLBTT before and after therapy with lubiprostone showed 18.9% reduction of this regional transit time with median being 46.24h (30.97-80.47) at baseline and 37.55h (24.49-54.21) while on medication (P=0.128). Conclusions: 1) During treatment with lubiprostone the acceleration of SBTT is more pronounced that colon transit in CC patients. 2) This implies that type 2 chloride channel activation within the small bowel does affect small intestine motility patterns in patients with chronic constipation. 3) The very modest delay in gastric emptying was not accompanied by clinically relevant nausea and is unlikely to explain the nausea side effect profile of lubiprostone.

Mo2092 Wireless Motility Capsule Alters Diagnosis and Affects Clinical Management in Patients With Suspected Gastrointestinal Dysmotility

BACKGROUND: The wireless motility capsule (WMC) is a novel device which is FDAapproved for the evaluation of suspected gastroparesis and slow-transit constipation. WMC provides information regarding pH, temperature and pressure throughout the GI tract and can be used to assess regional and whole-gut transit and pressure patterns. Several studies have validated WMC findings versus standard motility testing; however, there is limited data examining how WMC findings affect clinical care. AIMS: Aims were to investigate (1) the diagnostic yield of WMC in patients with suspected dysmotility and (2) change in clinicalmanagement afterWMC testing, includingmedication changes, referrals for additional diagnostic tests, and outside referrals. METHODS: We retrospectively reviewed 51 consecutive patients referred for WMC at a single, academic tertiary care center from April 2009 to October 2012. Information on demographics, past medical and surgical history, indications for WMC, WMC transit times, and relevant diagnostic studies were collected. Changes in clinical management at the first clinic visit after WMC testing were identified. Patients were excluded if WMC testing was incomplete or if no follow-up information was available. RESULTS: Patient characteristics including demographics and indications are summarized in Table 1. Results of positive WMC testing are summarized in Table 2A. Pan-GI dysmotility was present in 53% of patients with positive WMC testing. Effects of WMC results on diagnosis and management are summarized in Table 2B. Medication changes were more commonly seen in patients with an abnormal WMC test and included the addition or removal of prokinetics, antibiotics, herbal supplements, and neuromodulators. There were no statistically significant differences in additional imaging studies and referrals between the two groups. Referrals to non-GI providers included psychiatry, surgery, nutrition, acupuncture, and biofeedback. The presence of existing psychiatric comorbidities was also similar between groups. Of note, 80% of patients had other diagnostic studies obtained concurrently with WMC testing; however, attempts were made to isolate clinical changes made from WMC results specifically. CONCLUSIONS:WMC affects clinical management in the majority of patients referred for suspected dysmotility. Alteration in diagnosis was frequent, and change in medication was made for the majority of patients with abnormal WMC testing. Pan-GI dysmotility was common in patients referred for suspected regional dysmotility. Normal WMC testing changed clinical management in over 50% of cases. Our results suggest that WMC testing impacts patient care by altering diagnosis and clinical management. Prospective studies are needed to determine how WMC may affect long-term outcomes. Table 1. Patient Characteristics (N=51)

Generalized Transit Delay on Wireless Motility Capsule in Patients with Clinical Suspicion of Gastroparesis, Intestinal Dysmotility, or Slow Transit Constipation

Generalized Transit Delay on Wireless Motility Capsule in Patients with Clinical Suspicion of Gastroparesis, Intestinal Dysmotility, or Slow Transit Constipation

Wireless Motility Capsule in Patients with Constipation: Use in Clinical Practice

Wireless Motility Capsule in Patients with Constipation: Use in Clinical Practice