Small bowel transit does not correlate with outcome of surgery in patients with colonic inertia

Generalized transit delay on wireless motility capsule testing in patients with clinical suspicion of gastroparesis, small intestinal dysmotility, or slow transit constipation

BACKGROUND

The prevalence of generalized transit delay and relation to symptoms in suspected gastroparesis, intestinal dysmotility, or slow transit constipation are unknown.

AIMS

The aims of this study were (1) to define prevalence of generalized dysmotility using wireless motility capsules (WMC), (2) to relate to symptoms in suspected regional delay, (3) to compare results of WMC testing to conventional transit studies to quantify new diagnoses, and (4) to assess the impact of results of WMC testing on clinical decisions.

METHODS

WMC transits were analyzed in 83 patients with suspected gastroparesis, intestinal dysmotility, or slow transit constipation.

RESULTS

Isolated regional delays were observed in 32% (9% stomach, 5% small bowel, 18% colon). Transits were normal in 32% and showed generalized delays in 35%. Symptom profiles were similar with normal transit, isolated delayed gastric, small intestinal, and colonic transit, and generalized delay (P = NS). Compared to conventional tests, WMC showed discordance in 38% and provided new diagnoses in 53%. WMC testing influenced management in 67% (new medications 60%; modified nutritional regimens 14%; surgical referrals 6%) and eliminated needs for testing not already done including gastric scintigraphy (17%), small bowel barium transit (54%), and radioopaque colon marker tests (68%).

CONCLUSIONS

WMC testing defines localized and generalized transit delays with suspected gastroparesis, intestinal dysmotility, or slow transit constipation. Symptoms do not predict the results of WMC testing. WMC findings provide new diagnoses in >50%, may be discordant with conventional tests, and can influence management by changing treatments and eliminating needs for other tests. These findings suggest potential benefits of this method in suspected dysmotility syndromes and mandate prospective investigation to further define its clinical role.

Intestinal and anorectal motility and functional disorders

Motility and functional disorders of the small intestine, the colon and the anorectum can induce or contribute to symptoms such as diarrhoea, constipation and abdominal pain and may impair nutrient absorption in severe cases. Acute affections of intestinal functions e.g. during gastrointestinal infections usually need no functional diagnostics but resolve spontaneously or with adequate therapy of the underlying disease. By contrast, chronic disturbances of small intestinal, colonic and anorectal motility and/or sensitivity are subject to gastrointestinal function tests. The role of these tests for diagnosis and therapeutic handling of severe intestinal dysmotility/chronic intestinal pseudo-obstruction, severe constipation, diarrhoea, fecal incontinence and irritable bowel syndrome will be discussed in this review that mainly focuses on adults.