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Gollifer RM, Taylor SA, Menys A, Zarate‐Lopez N, Chatoor D, Emmanuel A, Atkinson D. Magnetic resonance imaging assessed enteric motility and luminal content analysis in patients with severe bloating and visible distension. Neurogastroenterol Motil 2022; 34:e14381. [PMID: 35438218 PMCID: PMC9786248 DOI: 10.1111/nmo.14381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 02/22/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Gastrointestinal symptoms in functional gut disorders occur without any discernible structural gut abnormality. Preliminary observations on enteric MRI suggest possible abnormal content and motility of the terminal ileum (TI) in constipation-predominant IBS (IBS-C) with severe bloating, and in functional bloating and distension (FABD) patients. We investigated whether MRI can quantify differences in small bowel (SB) content and motility between patients and healthy controls (HCs). METHODS 11 IBS-C (mean age 40 [21-52] years; 10 women) and 7 FABD (36 [21-56]; all women) patients with bloating and 20 HCs (28 [22-48]; 6 women) underwent enteric MRI, including dynamic motility and anatomical sequences. Three texture analysis (TA) parameters assessed the homogeneity of the luminal content, with ratios calculated between the TI and (1) the SB and (2) the ascending colon. Four TI motility metrics were derived. Ascending colon diameter (ACD) was measured. A comparison between HCs and patients was performed independently for: (1) three TA parameters, (2) four TI motility metrics, and (3) ACD. KEY RESULTS Compared with HCs, patients had TI:colon ratios higher for TA contrast (p < 0.001), decreased TI motility (lower mean motility [p = 0.04], spatial motility variation [p = 0.03], and area of motile TI [p = 0.03]), and increased ACD (p = 0.001). CONCLUSIONS AND INFERENCES IBS-C and FABD patients show reduced TI motility and differences in luminal content compared with HCs. This potentially indicates reflux of colonic contents or delayed clearance of the TI, which alongside increased ACD may contribute to symptoms of constipation and bloating.
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Affiliation(s)
| | - Stuart A. Taylor
- Centre for Medical ImagingUniversity College London (UCL)LondonUK
| | - Alex Menys
- Centre for Medical ImagingUniversity College London (UCL)LondonUK
| | | | - Dave Chatoor
- Department of GastroenterologyUniversity College London HospitalsLondonUK
| | - Anton Emmanuel
- Department of GastroenterologyUniversity College London HospitalsLondonUK
| | - David Atkinson
- Centre for Medical ImagingUniversity College London (UCL)LondonUK
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2
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Willis D, Cameron D, Kasmai B, Vassiliou VS, Malcolm PN, Baio G. A novel method for measuring bowel motility and velocity with dynamic magnetic resonance imaging in two and three dimensions. NMR IN BIOMEDICINE 2022; 35:e4663. [PMID: 34913200 DOI: 10.1002/nbm.4663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 11/02/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
Increasingly, dynamic magnetic resonance imaging (MRI) has potential as a noninvasive and accessible tool for diagnosing and monitoring gastrointestinal motility in healthy and diseased bowel. However, current MRI methods of measuring bowel motility have limitations: requiring bowel preparation or long acquisition times; providing mainly surrogate measures of motion; and estimating bowel-wall movement in just two dimensions. In this proof-of-concept study we apply a method that provides a quantitative measure of motion within the bowel, in both two and three dimensions, using existing, vendor-implemented MRI pulse sequences with minimal bowel preparation. This method uses a minimised cost function to fit linear vectors in the spatial and temporal domains. It is sensitised to the spatial scale of the bowel and aims to address issues relating to the low signal-to-noise in high-temporal resolution dynamic MRI scans, previously compensated for by performing thick-slice (10-mm) two-dimensional (2D) coronal scans. We applied both 2D and three-dimensional (3D) scanning protocols in two healthy volunteers. For 2D scanning, analysis yielded bi-modal velocity peaks, with a mean antegrade motion of 5.5 mm/s and an additional peak at ~9 mm/s corresponding to longitudinal peristalsis, as supported by intraoperative data from the literature. Furthermore, 3D scans indicated a mean forward motion of 4.7 mm/s, and degrees of antegrade and retrograde motion were also established. These measures show promise for the noninvasive assessment of bowel motility, and have the potential to be tuned to particular regions of interest and behaviours within the bowel.
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Affiliation(s)
- David Willis
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Donnie Cameron
- Norwich Medical School, University of East Anglia, Norwich, UK
- C. J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bahman Kasmai
- Department of Radiology, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
| | | | - Paul N Malcolm
- Department of Radiology, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
| | - Gabriella Baio
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Radiology, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
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3
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Costa M, Wiklendt L, Hibberd T, Dinning P, Spencer NJ, Brookes S. Analysis of Intestinal Movements with Spatiotemporal Maps: Beyond Anatomy and Physiology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1383:271-294. [PMID: 36587166 DOI: 10.1007/978-3-031-05843-1_26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Over 150 years ago, methods for quantitative analysis of gastrointestinal motor patterns first appeared. Graphic representations of physiological variables were recorded with the kymograph after the mid-1800s. Changes in force or length of intestinal muscles could be quantified, however most recordings were limited to a single point along the digestive tract.In parallel, photography and cinematography with X-Rays visualised changes in intestinal shape, but were hard to quantify. More recently, the ability to record physiological events at many sites along the gut in combination with computer processing allowed construction of spatiotemporal maps. These included diameter maps (DMaps), constructed from video recordings of intestinal movements and pressure maps (PMaps), constructed using data from high-resolution manometry catheters. Combining different kinds of spatiotemporal maps revealed additional details about gut wall status, including compliance, which relates forces to changes in length. Plotting compliance values along the intestine enabled combined DPMaps to be constructed, which can distinguish active contractions and relaxations from passive changes. From combinations of spatiotemporal maps, it is possible to deduce the role of enteric circuits and pacemaker cells in the generation of complex motor patterns. Development and application of spatiotemporal methods to normal and abnormal motor patterns in animals and humans is ongoing, with further technical improvements arising from their combination with impedance manometry, magnetic resonance imaging, electrophysiology, and ultrasonography.
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Affiliation(s)
- Marcello Costa
- College of Medicine and Public Health, Department of Human Physiology, Flinders University, Bedford Park, SA, Australia.
| | - Luke Wiklendt
- Department of Gastroenterology and Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Tim Hibberd
- College of Medicine and Public Health, Department of Human Physiology, Flinders University, Bedford Park, SA, Australia
| | - Phil Dinning
- Department of Gastroenterology and Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Nick J Spencer
- College of Medicine and Public Health, Department of Human Physiology, Flinders University, Bedford Park, SA, Australia
| | - Simon Brookes
- College of Medicine and Public Health, Department of Human Physiology, Flinders University, Bedford Park, SA, Australia
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4
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Dellschaft NS, Ng C, Hoad C, Marciani L, Spiller R, Stewart I, Menys A, Barr H, Gowland PA, Major G, Smyth AR. Magnetic resonance imaging of the gastrointestinal tract shows reduced small bowel motility and altered chyme in cystic fibrosis compared to controls. J Cyst Fibros 2021; 21:502-505. [PMID: 34922853 DOI: 10.1016/j.jcf.2021.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/20/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022]
Abstract
People with cystic fibrosis (CF) experience digestive symptoms but the mechanisms are incompletely understood. Here we explore causes and consequences of slower gastrointestinal transit using magnetic resonance imaging (MRI). Twelve people with CF and 12 healthy controls, matched for age and gender, underwent MRI scans, both fasted and after standardised meals, over 6.5 h. Fasted small bowel motility scores were lower in CF than in controls. No difference in ascending colon chyme T1 was detected. The difference in texture between small bowel and colon contents, seen in health, was diminished in CF. The ascending colon in CF participants had an abnormal appearance compared to controls. MRI offers unique potential to evaluate gut luminal content, colonic mucosa and intestinal motor activity. These new data support the theoretical cycle of desiccation, dysmotility and delayed transit as a cause of gastrointestinal symptoms in CF.
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Affiliation(s)
- Neele S Dellschaft
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and School of Medicine, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, UK
| | - Christabella Ng
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and School of Medicine, University of Nottingham, Nottingham, UK; Divisiof Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, UK
| | - Caroline Hoad
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and School of Medicine, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, UK
| | - Luca Marciani
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and School of Medicine, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, UK; NDigestive Diseases Centre, School of Medicine, University of Nottingham, UK
| | - Robin Spiller
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and School of Medicine, University of Nottingham, Nottingham, UK; NDigestive Diseases Centre, School of Medicine, University of Nottingham, UK
| | - Iain Stewart
- National Heart and Lung Institute, Imperial College London, UK
| | - Alex Menys
- Centre for Medical Imaging, Division of Medicine, University College London, UK
| | - Helen Barr
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and School of Medicine, University of Nottingham, Nottingham, UK; Wolfson Cystic Fibrosis Unit, Nottingham University Hospitals NHS Trust, UK
| | - Penny A Gowland
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and School of Medicine, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, UK
| | - Giles Major
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and School of Medicine, University of Nottingham, Nottingham, UK; NDigestive Diseases Centre, School of Medicine, University of Nottingham, UK
| | - Alan R Smyth
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and School of Medicine, University of Nottingham, Nottingham, UK; Divisiof Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, UK.
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5
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Steinsvik EK, Hatlebakk JG, Hausken T, Nylund K, Gilja OH. Ultrasound imaging for assessing functions of the GI tract. Physiol Meas 2021; 42:024002. [PMID: 33434898 DOI: 10.1088/1361-6579/abdad7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE In the following review we outline how ultrasound can be used to measure physiological processes in the gastrointestinal tract. APPROACH We have investigated the potential of ultrasound in assessing gastrointestinal physiology including original research regarding both basic methodology and clinical applications. MAIN RESULTS Our main findings show the use of ultrasound to study esophageal motility, measure volume and contractility of the stomach, assess motility, wall thickness, and perfusion of the small bowel, and evaluate wall vascularization and diameters of the large bowel. SIGNIFICANCE Ultrasound is a widely accessible technology that can be used for both scientific and clinical purposes. Being radiation-free and user friendly, the examination can be frequently repeated enabling longitudinal studies. Furthermore, it does not influence normal GI physiology, thus being useful to estimate motility and subtle changes in physiology. Accordingly, ultrasound scanning and physiological measurements may make a big difference for the scientist and the doctor; and for the patients who receive an efficient work-up.
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Affiliation(s)
- Elisabeth K Steinsvik
- National Center for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Gunnar Hatlebakk
- National Center for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Trygve Hausken
- National Center for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kim Nylund
- National Center for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Odd Helge Gilja
- National Center for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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6
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Tsume Y, Patel S, Wang M, Hermans A, Kesisoglou F. The Introduction of a New Flexible In Vivo Predictive Dissolution Apparatus, GIS-Alpha (GIS-α), to Study Dissolution Profiles of BCS Class IIb Drugs, Dipyridamole and Ketoconazole. J Pharm Sci 2020; 109:3471-3479. [PMID: 32888960 DOI: 10.1016/j.xphs.2020.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/07/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
The physiological pH changes and peristalsis activities in gastrointestinal (GI) tract have big impact on the dissolution of oral drug products, when those oral drug products include APIs with pH-dependent solubility. It is well documented that predicting the bioperformance of those oral drug products can be challenging using compendial methods. To overcome this limitation, in vivo predictive dissolution apparatuses, such as the transfer model, have been developed to predict bioperformance of oral formulation candidates and drug products. In this manuscript we utilize a new transfer-model dissolution apparatus, the gastrointestinal simulator-α (GIS-α), to characterize its behavior in terms of transfer kinetics and pH, assess its reproducibility and adaptability to mimic different transfer conditions, as well as study dissolution of ketoconazole and dipyridamole as model BCS class IIb compounds. Availability of commercially available dissolution transfer systems with similar configuration to compendial dissolution apparatus, may be helpful to simplify and standardize in vivo predictive dissolution methodologies for BCS class IIb compounds in the future.
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Affiliation(s)
- Yasuhiro Tsume
- Biopharmaceutics, Merck & Co. Inc, Rahway, NJ 07065-0900, USA.
| | | | - Michael Wang
- Biopharmaceutics, Merck & Co. Inc, Rahway, NJ 07065-0900, USA
| | - Andre Hermans
- Analytical Science, Merck & Co. Inc, Rahway, NJ 07065-0900, USA
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7
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Khalaf A, Hoad CL, Menys A, Nowak A, Radford S, Taylor SA, Latief K, Lingaya M, Falcone Y, Singh G, Spiller RC, Gowland PA, Marciani L, Moran GW. Gastrointestinal peptides and small-bowel hypomotility are possible causes for fasting and postprandial symptoms in active Crohn's disease. Am J Clin Nutr 2020; 111:131-140. [PMID: 31557279 DOI: 10.1093/ajcn/nqz240] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) patients suffer postprandial aversive symptoms, which can lead to anorexia and malnutrition. Changes in the regulation of gut hormones and gut dysmotility are believed to play a role. OBJECTIVES This study aimed to investigate small-bowel motility and gut peptide responses to a standard test meal in CD by using MRI. METHODS We studied 15 CD patients with active disease (age 36 ± 3 y; BMI 26 ± 1 kg/m 2) and 20 healthy volunteers (HVs; age 31 ± 3 years; BMI 24 ± 1 kg/m 2). They underwent baseline and postprandial MRI scans, symptom questionnaires, and blood sampling following a 400-g soup meal (204 kcal). Small-bowel motility, other MRI parameters, and glucagon-like peptide-1 (GLP-1), polypeptide YY (PYY), and cholecystokinin peptides were measured. Data are presented as means ± SEMs. RESULTS HVs had significantly higher fasting motility indexes [106 ± 13 arbitrary units (a.u.)], compared with CD participants (70 ± 8 a.u.; P ≤ 0.05). Postprandial small-bowel water content showed a significant time by group interaction (P < 0.05), with CD participants showing higher levels from 210 min postprandially. Fasting concentrations of GLP-1 and PYY were significantly greater in CD participants, compared with HVs [GLP-1, CD 50 ± 8 µg/mL versus HV 13 ± 3 µg/mL (P ≤ 0.0001); PYY, CD 236 ± 16 pg/mL versus HV 118 ± 12 pg/mL (P ≤ 0.0001)]. The meal challenge induced a significant postprandial increase in aversive symptom scores (fullness, distention, bloating, abdominal pain, and sickness) in CD participants compared with HVs (P ≤ 0.05). CONCLUSIONS The decrease in fasting small-bowel motility noted in CD participants can be ascribed to the increased fasting gut peptides. A better understanding of the etiology of aversive symptoms in CD will facilitate identification of better therapeutic targets to improve nutritional status. This trial was registered at clinicaltrials.gov as NCT03052465.
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Affiliation(s)
- Asseel Khalaf
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute of Health Research Nottingham Biomedical Research Centre at Nottingham University, Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Caroline L Hoad
- National Institute of Health Research Nottingham Biomedical Research Centre at Nottingham University, Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | | | - Adam Nowak
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute of Health Research Nottingham Biomedical Research Centre at Nottingham University, Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Shellie Radford
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute of Health Research Nottingham Biomedical Research Centre at Nottingham University, Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Stuart A Taylor
- Centre for Medical Imaging, Division of Medicine, University College London, United Kingdom
| | - Khalid Latief
- Department of Radiology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Melanie Lingaya
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute of Health Research Nottingham Biomedical Research Centre at Nottingham University, Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Yirga Falcone
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute of Health Research Nottingham Biomedical Research Centre at Nottingham University, Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Gulzar Singh
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute of Health Research Nottingham Biomedical Research Centre at Nottingham University, Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Robin C Spiller
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute of Health Research Nottingham Biomedical Research Centre at Nottingham University, Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Penny A Gowland
- National Institute of Health Research Nottingham Biomedical Research Centre at Nottingham University, Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Luca Marciani
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute of Health Research Nottingham Biomedical Research Centre at Nottingham University, Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Gordon W Moran
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute of Health Research Nottingham Biomedical Research Centre at Nottingham University, Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
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8
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Spiller R, Hoad C. Enhancing our understanding of small bowel function using modern imaging techniques. Neurogastroenterol Motil 2020; 32:e13616. [PMID: 31136064 DOI: 10.1111/nmo.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 02/08/2023]
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.
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Affiliation(s)
- Robin Spiller
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Caroline Hoad
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, Department of Physics, University of Nottingham, Nottingham, UK
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9
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Lu J, Zhou Z, Morelli JN, Yu H, Luo Y, Hu X, Li Z, Hu D, Shen Y. A Systematic Review of Technical Parameters for MR of the Small Bowel in non-IBD Conditions over the Last Ten Years. Sci Rep 2019; 9:14100. [PMID: 31575890 PMCID: PMC6773732 DOI: 10.1038/s41598-019-50501-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/13/2019] [Indexed: 12/27/2022] Open
Abstract
Technical guidelines for magnetic resonance imaging (MRI) of the small bowel (SB) in the setting of inflammatory bowel diseases (IBDs) were detailed in a 2017 consensus issued by European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and European Society of Pediatric Radiology (ESPR); however, MRI for non-IBD conditions was not addressed. Hence, we performed a systematic review collecting researches on SB MRI for non-IBDs. The literatures were then divided into morphologic group and functional group. Information about the MRI techniques, gastrointestinal preparation, and details of cine-MRI protocols was extracted. We found that a 1.5 T MRI system, prone positioning, and MR enterography were frequently utilized in clinical practice. Gadolinium contrast sequences were routinely implemented, while diffusion-weighted imaging (DWI) was much less performed. The gastrointestinal preparation varied throughout the studies. No uniform protocols for cine imaging could be established. SB MRI examinations for non-IBDs are far from standardized, especially for functional studies. Recommendations for standard parameters in cine-MRI sequences are difficult to make due to lack of evidentiary support. MRI investigations in non-IBD conditions are needed and the standardization of non-IBD imaging in clinical practice is required.
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Affiliation(s)
- Jingyu Lu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ziling Zhou
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Hao Yu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Luo
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuemei Hu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhen Li
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Daoyu Hu
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yaqi Shen
- Departments of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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10
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Automated versus subjective assessment of spatial and temporal MRI small bowel motility in Crohn's disease. Clin Radiol 2019; 74:814.e9-814.e19. [DOI: 10.1016/j.crad.2019.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022]
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11
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Mitsuyoshi Y, Takakura K, Kobayashi T, Ogawa N, Sakurai T, Nakano M, Ukichi T, Ishiuji Y, Torisu Y, Saruta M. Chronic intestinal pseudo-obstruction with pneumatosis cystoides intestinalis in a patient with systemic sclerosis: A case report. Medicine (Baltimore) 2019; 98:e15480. [PMID: 31045831 PMCID: PMC6504328 DOI: 10.1097/md.0000000000015480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Chronic intestinal pseudo-obstruction (CIPO) and pneumatosis cystoides intestinalis (PCI) are rare abdominal diseases and the pathological mechanisms have not been fully elucidated. Systemic sclerosis (SSc), which is characterized by the progressive sclerotic changes of skin and internal organs, is a refractory collagen disease and is frequently associated with digestive disorders including CIPO. PATIENT CONCERNS A 68-year-old woman who has been well managed for SSc over the long term, who presented with abdominal fullness for the first time. DIAGNOSES Abdominal X-ray and computed tomography (CT) images showed PCI with pneumoperitoneum findings. Based on the diagnosis of CIPO, we evaluated the intestinal peristalsis of the patient by using cine magnetic resonance imaging (MRI). INTERVENTIONS Oral medications of 15 g/d of Daikenchuto, 750 mg/d of Metronidazole and Sodium Picosulfate were started for improving the bowel peristaltic movement and decreasing intestinal gas production. OUTCOMES A great improvement of CIPO and PCI by multidrug therapy without any surgical treatments for such an unusual case. LESSONS This case indicates that SSc can be accompanied with not only CIPO but also PCI as digestive disorders and that cine MRI, which is a definitely beneficial imaging modality, can intelligibly visualize the peristalsis of the intestines and lead to successful medical control by noninvasive treatment.
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Affiliation(s)
| | | | | | | | | | | | - Taro Ukichi
- Division of Rheumatology, Department of Internal Medicine
| | - Yozo Ishiuji
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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