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Wolfson S, Saps M. Recent advances in treating constipation in children. Expert Rev Gastroenterol Hepatol 2024:1-14. [PMID: 39034812 DOI: 10.1080/17474124.2024.2383636] [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: 04/13/2024] [Accepted: 07/19/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Functional constipation (FC) is a common childhood condition, diagnosed via the Rome IV criteria. Standard therapy includes lifestyle and dietary modification followed by initiation of osmotic laxative therapy. About 30% of children continue to experience symptoms related to FC despite appropriate management. New pharmacologic, surgical, and neuromodulatory therapies for FC are now available for use in adult and pediatric populations. In 2023, the first pharmacologic agent, linaclotide, obtained FDA approval for treatment of FC in children 6-17 years old. AREAS COVERED This article reviews current and emerging pharmacologic, surgical, and neuromodulation therapies for the management of FC in pediatric patients. Efficacy and safety data regarding each of these modalities was reviewed and discussed. EXPERT OPINION Advancements in therapeutics available for the management of FC necessitate further investigation on safety and efficacy in pediatric populations. Careful consideration should be taken in choosing an available treatment with limited pediatric evidence as adult and pediatric FC have different underlying pathophysiology and require a different therapeutic approach. Standardization of methodology and pediatric endpoints are needed to optimize ability to compare efficacy of different treatments. We predict the future of pediatric FC management will include a personalized approach to care, resulting in improved outcomes.
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Affiliation(s)
- Sharon Wolfson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Miguel Saps
- Division of Pediatric Gastroenterology,Hepatology and Nutrition, University of Miami, Miami, FL, USA
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Sonu I, Oh SJ, Rao SSC. Capsules for the Diagnosis and Treatment of Gastrointestinal Motility Disorders- A Game Changer. Curr Gastroenterol Rep 2024; 26:157-165. [PMID: 38630422 DOI: 10.1007/s11894-024-00926-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE OF REVIEW Over the last few decades, there have been remarkable strides in endoscopy and radiological imaging that have advanced gastroenterology. However, the management of neurogastroenterological disorders has lagged behind, in part handicapped by the use of catheter-based manometry that is both non-physiological and uncomfortable. The advent of capsule technology has been a game changer for both diagnostic and therapeutic applications. RECENT FINDINGS Here, we discuss several capsule devices that are available or under investigation. There are three technologies that are FDA approved. Wireless motility capsule measures pH and pressure and provides clinically impactful information regarding gastric, small intestine and colonic transit, without radiation that has been demonstrated to guide management of gastroparesis, dyspepsia and constipation. Wireless ambulatory pH monitoring capsule is currently the gold standard for assessing gastroesophageal acid reflux. In the therapeutics arena, an orally ingested vibrating capsule has been recently FDA approved for the treatment of chronic constipation, supported by a robust phase 3 clinical trial which showed significant improvement in constipation symptoms and quality of life. There are several capsules currently under investigation. Smart capsule bacterial detection system and Capscan® are capsules that can sample fluid in the small or large bowel and provide microbiome analysis for detection of small intestinal bacterial (SIBO) or fungal overgrowth (SIFO). Another investigational gas sensing capsule analyzing hydrogen, CO2, volatile fatty acids and capsule orientation, can measure regional gut transit time and luminal gas concentrations and assess gastroparesis, constipation or SIBO. Therapeutically, other vibrating capsules are in development. Innovations in capsule technology are poised to transform our ability to investigate gut function physiologically, and non-invasively deliver targeted treatment(s), thereby providing both accurate diagnostic information and luminally-directed, safe therapy.
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Affiliation(s)
| | - Sun Jung Oh
- Johns Hopkins University, Baltimore, MD, USA
| | - Satish S C Rao
- Division of Gastroenterology and Hepatology, Medical College of Georgia, Augusta University, 1120 15th Street, BBR 2538, Augusta, GA, 30912, USA.
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3
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Haghbin H, Zakirkhodjaev N, Gangwani MK, Beran A, Lee-Smith W, Piper MH, Aziz M. Efficacy and safety of vibrating capsule in treatment of chronic idiopathic constipation: a systematic review and meta-analysis of randomized controlled trials. Transl Gastroenterol Hepatol 2024; 9:8. [PMID: 38317751 PMCID: PMC10838609 DOI: 10.21037/tgh-23-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/10/2023] [Indexed: 02/07/2024] Open
Abstract
Background Multiple pharmacological interventions and modalities are available for managing chronic idiopathic constipation (CIC), with variable efficacy. Vibrating capsule (VC) is a device that has shown variable results in alleviating constipation by tactile stimulation of the colonic wall and inducing peristalsis. This meta-analysis is to investigate the efficacy and safety of this modality. Methods Comprehensive literature search was performed through June 14th, 2023, on databases including Embase, PubMed/MEDLINE, Cochrane Central, Web of Science, Global Index Medicus, and Google Scholar. Core concepts of VC, constipation, and bowel movement were searched. The DerSimonian-Laird method and random effects model were utilized. We calculated odds ratio (OR) and mean difference (MD) for proportional and continuous variables, respectively, with 95% confidence interval (CI) and a P value of <0.05 considered statistically significant. Results The search strategy yielded 117 articles. Four studies with 705 total patients were finalized comparing VC to placebo/sham treatment. The pooled complete spontaneous bowel movement (CSBM), defined as bowel movement without use of laxatives within the last 48 hours with sense of complete evacuation did not achieve statistical improvement with VC (MD =0.153; 95% CI: -0.218 to 0.523; P=0.422). However, spontaneous bowel movement (SBM), defined as bowel movement without use of laxatives within the last 48 hours, showed statistical improvement with VC (MD =0.159; 95% CI: 0.095 to 0.223; P<0.001). VC didn't show an increase in pooled adverse events (OR =1.431; 95% CI: 0.702 to 2.916; P=0.324). Conclusions The systematic review and meta-analysis suggest that VC is safe and efficacious in some outcomes, however, larger randomized controlled trials (RCTs) and real-world data are needed to establish this.
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Affiliation(s)
- Hossein Haghbin
- Division of Gastroenterology, Ascension Providence Hospital, Southfield, MI, USA
| | - Nurruddinkhodja Zakirkhodjaev
- Division of Occupational and Environmental Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Azizullah Beran
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | - Michael H. Piper
- Division of Gastroenterology, Ascension Providence Hospital, Southfield, MI, USA
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
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4
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Uwawah TD, Nduma BN, Nkeonye S, Kaur D, Ekhator C. A Novel Vibrating Capsule Treatment for Constipation: A Review of the Literature. Cureus 2024; 16:e52943. [PMID: 38406016 PMCID: PMC10894038 DOI: 10.7759/cureus.52943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Constipation is a pretty common and sometimes complicated health condition around the world which is characterized by an inability to have regular bowel movements. In response to this worrying trend, various pharmacological and non-pharmacological interventions have been embraced to seek to produce promising outcomes, yet patient dissatisfaction continues to be reported. The main aim of this review paper was to determine the effectiveness and safety of the vibrating capsule in treating constipated patients. The key databases that were consulted to get articles on this subject include Google Scholar, Embase, and PubMed. Specific keywords were used in the database search to get the relevant articles. Based on the exclusion criterion, articles that were excluded include conference abstracts, commentaries, preclinical research articles, articles where full texts were inaccessible, and those that had been published in a language other than English. From the results, the safety profile of the vibrating capsule suggests that the intervention is generally well-tolerated, with only mild and transient side effects or adverse events noted, including abdominal discomfort and sensations of mild vibration. However, the impact of these adverse events (although mild to moderate) on the efficacy of the capsule remains unknown, an area requiring further scholarly attention in the future. Concerning the efficacy of the intervention, most studies were found to affirm that the vibrating capsule enhances the physiologic effects of meals and waking on bowel movements, but the need for providers in clinical environments to note the interplay between the number of vibrations and the effectiveness of the capsule or onset of complete spontaneous bowel movements could not be overemphasized. In conclusion, this paper established that the vibrating capsule is an effective and promising technology through which constipated patients could be treated while experiencing minimal or no adverse events, but future research efforts ought to seek to uncover the interplay between the mechanism of action of the capsule and any moderating role played by factors internal or external to patients, including their emotional, mental, and psychological statuses, as well as the type and quantity of food consumed before and after the vibration sessions.
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Affiliation(s)
| | - Basil N Nduma
- Internal Medicine, Medical City Hospital, Denton, USA
| | - Stephen Nkeonye
- Research and Development, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Davinder Kaur
- Internal Medicine, Medical City Hospital, North Hill, USA
| | - Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
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5
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Maciejczyk M, Bawelski M, Wiecek M, Palka T, Bujas P, Piotrowska A, Szygula Z. Resting metabolic rate is increased after a series of whole body vibration in young men. Sci Rep 2023; 13:17165. [PMID: 37821545 PMCID: PMC10567801 DOI: 10.1038/s41598-023-44543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/10/2023] [Indexed: 10/13/2023] Open
Abstract
Resting metabolic rate (RMR) is the largest component of total energy expenditure and increasing it can be of great importance in reducing excess body fatness. Whole body vibration (WBV) can affect energy expenditure during single session of WBV, but the effects of repeated WBV on resting metabolic rate have not been reported. The purpose of this study was to investigate whether a series of WBV would increase resting metabolism in young men. Thirty-two healthy men aged of 21-23 were recruited and randomly assigned to two 16-member groups: a group participating in the WBV intervention and a group without the intervention. The intervention lasted 2 weeks and WBV was performed 5 times a week. Diet, physical activity, body composition and resting metabolic rate were analyzed in the participants. In WBV group significantly increased resting oxygen uptake (p = 0.049) and consequently RMR (p = 0.035) after the intervention. Similar changes were not observed in the control group. This indicates that applied type of vibration in this study can be an addition to obesity therapy, in which, WBV can, among other beneficial metabolic effects, increase RMR and thus total energy expenditure.
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Affiliation(s)
- Marcin Maciejczyk
- Department of Physiology and Biochemistry, University of Physical Education, Kraków, Poland.
| | - Marek Bawelski
- Department of Physiology and Biochemistry, University of Physical Education, Kraków, Poland
| | - Magdalena Wiecek
- Department of Physiology and Biochemistry, University of Physical Education, Kraków, Poland
| | - Tomasz Palka
- Department of Physiology and Biochemistry, University of Physical Education, Kraków, Poland
| | - Przemyslaw Bujas
- Department of Theory of Sport and Kinesiology, University of Physical Education, Kraków, Poland
| | - Anna Piotrowska
- Department of Chemistry and Biochemistry, University of Physical Education, Kraków, Poland
| | - Zbigniew Szygula
- Department of Nutrition and Sport Medicine, University of Physical Education, Kraków, Poland
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6
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Saeed A, Abuelazm MT, Abdelnabi M, Elewidi M, Khaled A, Elzahaby A, Mousa A, Abdelazeem B. The efficacy and safety of vibrating capsules for functional constipation: a systematic review and meta-analysis of randomized controlled trials. Curr Med Res Opin 2023; 39:1195-1204. [PMID: 37526021 DOI: 10.1080/03007995.2023.2243219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/16/2023] [Accepted: 07/28/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Chronic constipation is a challenging functional gastrointestinal disorder that remains a global burden. Pharmacologic therapy, including laxatives and dietary fibers, are suggested as lines of treatment. Recent trials introduced an orally ingested vibrating capsule (VC) as an eligible option for chronic constipation management. METHODS We conducted a literature search in English on electronic databases CENTRAL, PubMed, EMBASE, Scopus, and WOS until February 27th, 2023. RevMan was used to perform the meta-analysis. The results were reported as risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs). The study protocol was registered in PROSPERO with ID: (CRD42023409422). RESULTS Three RCTs with a total of 601 patients were included in our analysis. There was no difference between the VC and placebo in responder rate (RR: 1.37 with 95% CI [0.82, 2.28], p = .22), CSBM change from baseline (MD: 0.21 with 95% CI [-0.26, 0.69], p = .38), SBM change from baseline (MD: 0.14 with 95% CI [-0.22, 0.49], p = .46), and the incidence of any adverse event (RR: 1.45 with a 95% CI of [0.79, 2.63], p = .23). However, VC was associated with increased vibration sensation (RR: 17.23, 95% CI [3.29, 90.20], p = .0008). CONCLUSIONS VC was not effective to improve bowel movement in patients with functional constipation with no difference in response rate. However, evidence is still uncertain, with only three small RCTs that yielded heterogenous findings, mainly due to the different vibration protocols. Also, our findings suggest that VC is safe and well-tolerated, with no significant harmful effects observed. Therefore, more large-scale RCTs are needed to confirm the efficacy and safety of VC in patients with functional constipation, determining the most effective dose, frequency, and duration of treatment.
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Affiliation(s)
| | | | - Mohamed Abdelnabi
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, MI, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
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Mayeli A, Al Zoubi O, White EJ, Chappelle S, Kuplicki R, Morton A, Bruce J, Smith R, Feinstein JS, Bodurka J, Paulus MP, Khalsa SS. Parieto-occipital ERP indicators of gut mechanosensation in humans. Nat Commun 2023; 14:3398. [PMID: 37311748 PMCID: PMC10264354 DOI: 10.1038/s41467-023-39058-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 05/24/2023] [Indexed: 06/15/2023] Open
Abstract
Understanding the neural processes governing the human gut-brain connection has been challenging due to the inaccessibility of the body's interior. Here, we investigated neural responses to gastrointestinal sensation using a minimally invasive mechanosensory probe by quantifying brain, stomach, and perceptual responses following the ingestion of a vibrating capsule. Participants successfully perceived capsule stimulation under two vibration conditions (normal and enhanced), as evidenced by above chance accuracy scores. Perceptual accuracy improved significantly during the enhanced relative to normal stimulation, which was associated with faster stimulation detection and reduced reaction time variability. Capsule stimulation induced late neural responses in parieto-occipital electrodes near the midline. Moreover, these 'gastric evoked potentials' showed intensity-dependent increases in amplitude and were significantly correlated with perceptual accuracy. Our results replicated in a separate experiment, and abdominal X-ray imaging localized most capsule stimulations to the gastroduodenal segments. Combined with our prior observation that a Bayesian model is capable of estimating computational parameters of gut-brain mechanosensation, these findings highlight a unique form of enterically-focused sensory monitoring within the human brain, with implications for understanding gut feelings and gut-brain interactions in healthy and clinical populations.
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Affiliation(s)
- Ahmad Mayeli
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Obada Al Zoubi
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Harvard Medical School/McLean Hospital, Boston, MA, USA
| | - Evan J White
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | | | - Alexa Morton
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Jaimee Bruce
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Stephenson School of Biomedical Engineering, University of Oklahoma, Tulsa, OK, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
| | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, USA.
- Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA.
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8
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Rao SSC, Quigley EMM, Chey WD, Sharma A, Lembo AJ. Randomized Placebo-Controlled Phase 3 Trial of Vibrating Capsule for Chronic Constipation. Gastroenterology 2023; 164:1202-1210.e6. [PMID: 36822371 DOI: 10.1053/j.gastro.2023.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND & AIMS Despite therapeutic advances, effective treatments for chronic constipation remain an unmet need. The vibrating capsule is a nonpharmacologic, orally ingested, programmable capsule that vibrates intraluminally to induce bowel movements. We aimed to determine the efficacy and safety of the vibrating capsule in patients with chronic constipation. METHODS We conducted a phase 3, double-blind, placebo-controlled trial of patients with chronic constipation, who were randomized to receive either a vibrating or placebo capsule, once daily, 5 days a week for 8 weeks. The primary efficacy end points were an increase of 1 or more complete spontaneous bowel movements per week (CSBM1 responder) or 2 or more CSBMs per week (CSBM2) from baseline during at least 6 of the 8 weeks. Safety analyses were performed. RESULTS Among 904 patients screened, 312 were enrolled. A greater percentage of patients receiving the vibrating capsule achieved both primary efficacy end points compared with placebo (39.3% vs 22.1%, P = .001 for CSBM1; 22.7% vs 11.4% P = .008 for CSBM2). Significantly greater improvements were seen with the vibrating capsule for the secondary end points of straining, stool consistency, and quality-of-life measures compared with placebo. Adverse events were mild, gastrointestinal in nature, and similar between groups, except that a mild vibrating sensation was reported by 11% of patients in the vibrating capsule group, but none withdrew from the trial. CONCLUSIONS In patients with chronic constipation, the vibrating capsule was superior to placebo in improving bowel symptoms and quality of life. The vibrating capsule was safe and well tolerated. (Clinical trials.gov, Number: NCT03879239).
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Affiliation(s)
- Satish S C Rao
- Division of Gastroenterology/Hepatology, Augusta University, Augusta, Georgia.
| | - Eamonn M M Quigley
- Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas
| | | | - Amol Sharma
- Division of Gastroenterology/Hepatology, Augusta University, Augusta, Georgia
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Sharma A, Rao S. Letter: non-invasive transabdominal stimulation device for the treatment of chronic constipation-proof-of-principle study in adults. Authors' reply. Aliment Pharmacol Ther 2022; 55:1357-1358. [PMID: 35472179 DOI: 10.1111/apt.16910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Amol Sharma
- Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Satish Rao
- Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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10
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Zhu JH, Qian YY, Pan J, He C, Lan Y, Chen WN, Wang BM, Zhao W, Li JN, Li XQ, Lv B, Fan YH, Zuo XL, Li Z, Zou DW, Li ZS, Liao Z. Efficacy and safety of vibrating capsule for functional constipation (VICONS): A randomised, double-blind, placebo-controlled, multicenter trial. EClinicalMedicine 2022; 47:101407. [PMID: 35518121 PMCID: PMC9062239 DOI: 10.1016/j.eclinm.2022.101407] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Functional constipation (FC) is an intractable disease that carries large financial burden as well as emotional and physical stress. We aimed to assess the efficacy and safety of the newly developed smartphone-controlled vibrating capsule (VC) in patients with FC. METHODS From December 2018 to February 2020, we did a multicenter, blinded, placebo-controlled randomised trial in six top general hospitals in China focusing on patients aged 18 to 80 with FC. Patients were randomly assigned in a 1:1 ratio to receive VCs or placebo treatment for six weeks (two capsules per week) after a two-week baseline period. The primary outcome was the responder rate, defined as the proportion of patients with an increase of at least one complete spontaneous bowel movement (CSBM) per week during treatment compared to baseline in the full analysis set. This trial is registered with ClinicalTrials.gov, number NCT04671264, and is completed. FINDINGS 107 patients aged from 18 to 74 were randomly assigned to receive VC (n = 53) or placebo treatment (n = 54). The responder rate in the VC group was significantly higher than that in the placebo group (64·2% vs. 35·8%; difference, 27·7% [95% CI, 10·4-45·1]; P = 0·005). More patients in the VC group reported weekly CSBMs ≥ 1 for at least four weeks during treatment (difference, 22·7% [95% CI, 8-46]; P = 0·022) and follow-up period (difference, 17.3% [95% CI, 0-35]; P = 0·048). The mean Patient Assessment of Constipation-Symptoms score and Patient Assessment of Constipation-Quality of Life score differed significantly from the baseline in both groups (all P < 0·0001). The most common adverse event associated with VC was abdominal discomfort (3·7%). INTERPRETATION VCs can promote defecation, as well as ameliorating symptoms and improving the quality of life in patients with FC with sustained efficacy. VC appears to be a potential alternative physical treatment for FC with the exact mechanism and parameters warranting further investigation. FUNDING The study was supported by "One hundred leading scientists for 21st century" of Health Department of Shanghai Municipal Government (to ZL, No.2017BR005).
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Affiliation(s)
- Jia-Hui Zhu
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
- National Clinical Research Center for Digestive Diseases, Shanghai, China
| | - Yang-Yang Qian
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
- National Clinical Research Center for Digestive Diseases, Shanghai, China
| | - Jun Pan
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
- National Clinical Research Center for Digestive Diseases, Shanghai, China
| | - Chen He
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
- National Clinical Research Center for Digestive Diseases, Shanghai, China
| | - Yu Lan
- Department of Gastroenterology, Beijing Jishuitan Hospital, Beijing, China
| | - Wei-Na Chen
- Department of Gastroenterology, Beijing Jishuitan Hospital, Beijing, China
| | - Bang-Mao Wang
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Zhao
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jing-Nan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Qing Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Lv
- Department of Gastroenterology, Zhejiang Provincial Hospital of TCM, Hangzhou, China
| | - Yi-Hong Fan
- Department of Gastroenterology, Zhejiang Provincial Hospital of TCM, Hangzhou, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhen Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Duo-Wu Zou
- Department of Gastroenterology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
- National Clinical Research Center for Digestive Diseases, Shanghai, China
| | - Zhuan Liao
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
- National Clinical Research Center for Digestive Diseases, Shanghai, China
- Corresponding author at: Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China.
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11
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Smart pills for gastrointestinal diagnostics and therapy. Adv Drug Deliv Rev 2021; 177:113931. [PMID: 34416311 DOI: 10.1016/j.addr.2021.113931] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 12/13/2022]
Abstract
Ingestible smart pills have the potential to be a powerful clinical tool in the diagnosis and treatment of gastrointestinal disease. Though examples of this technology, such as capsule endoscopy, have been successfully translated from the lab into clinically used products, there are still numerous challenges that need to be overcome. This review gives an overview of the research being done in the area of ingestible smart pills and reports on the technical challenges in this field.
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12
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Weitschies W, Müller L, Grimm M, Koziolek M. Ingestible devices for studying the gastrointestinal physiology and their application in oral biopharmaceutics. Adv Drug Deliv Rev 2021; 176:113853. [PMID: 34192551 DOI: 10.1016/j.addr.2021.113853] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/17/2022]
Abstract
Ingestible sensor systems are unique tools for obtaining physiological data from an undisturbed gastrointestinal tract. Since their dimensions correspond to monolithic oral dosage forms, such as enteric coated tablets or hydrogel matrix tablets, they also allow insights into the physiological conditions experienced by non-disintegrating dosage forms on their way through the gastrointestinal tract. In this work, the different ingestible sensor systems which can be used for this purpose are described and their potential applications as well as difficulties and pitfalls with respect to their use are presented. It is also highlighted how the data on transit times, pH, temperature and pressure as well as the data from different animal models commonly used in drug product development such as dogs and pigs have contributed to a deeper mechanistic understanding of oral drug delivery.
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Affiliation(s)
- Werner Weitschies
- Institute of Pharmacy, Center of Drug Absorption and Transport, University of Greifswald, Greifswald, Germany.
| | - Laura Müller
- Institute of Pharmacy, Center of Drug Absorption and Transport, University of Greifswald, Greifswald, Germany
| | - Michael Grimm
- Institute of Pharmacy, Center of Drug Absorption and Transport, University of Greifswald, Greifswald, Germany
| | - Mirko Koziolek
- NCE Formulation Sciences, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany
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Sharma A, Rao SSC, Kearns K, Orleck KD, Waldman SA. Review article: diagnosis, management and patient perspectives of the spectrum of constipation disorders. Aliment Pharmacol Ther 2021; 53:1250-1267. [PMID: 33909919 PMCID: PMC8252518 DOI: 10.1111/apt.16369] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/24/2020] [Accepted: 03/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic constipation is a common, heterogeneous disorder with multiple symptoms and pathophysiological mechanisms. Patients are often referred to a gastroenterology provider after laxatives fail. However, there is limited knowledge of the spectrum and management of constipation disorders. AIM To discuss the latest understanding of the spectrum of constipation disorders, tools for identifying a pathophysiologic-based diagnosis in the specialist setting, treatment options and the patient's perspective of constipation. METHODS Literature searches were conducted using PubMed for constipation diagnostic criteria, diagnostic tools and approved treatments. The authors provided insight from their own practices. RESULTS Clinical assessment, stool diaries and Rome IV diagnostic criteria can facilitate diagnosis, evaluate severity and distinguish between IBS with constipation, chronic idiopathic constipation and dyssynergic defecation. Novel smartphone applications can help track constipation symptoms. Rectal examinations, anorectal manometry and balloon expulsion, assessments of neuromuscular function with colonic transit time and colonic manometry can provide mechanistic understanding of underlying pathophysiology. Treatments include lifestyle and diet changes, biofeedback therapy and pharmacological agents. Several classes of laxatives, as well as prokinetic and prosecretory agents, are available; here we describe their mechanisms of action, efficacy and side effects. CONCLUSIONS Constipation includes multiple overlapping subtypes identifiable using detailed history, current diagnostic tools and smartphone applications. Recognition of individual subtype(s) could pave the way for optimal, evidence-based treatments by a gastroenterology provider.
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Affiliation(s)
- Amol Sharma
- Division of Gastroenterology/HepatologyMedical College of GeorgiaAugusta UniversityAugustaGAUSA
| | - Satish S. C. Rao
- Division of Gastroenterology/HepatologyMedical College of GeorgiaAugusta UniversityAugustaGAUSA
| | | | | | - Scott A. Waldman
- Department of Pharmacology and Experimental TherapeuticsThomas Jefferson UniversityPhiladelphiaPAUSA
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