1
|
Lam C, Chaddock G, Marciani L, Costigan C, Paul J, Cox E, Hoad C, Menys A, Pritchard S, Garsed K, Taylor S, Atkinson D, Gowland P, Spiller R. Colonic response to laxative ingestion as assessed by MRI differs in constipated irritable bowel syndrome compared to functional constipation. Neurogastroenterol Motil 2016; 28:861-70. [PMID: 26871949 PMCID: PMC4949702 DOI: 10.1111/nmo.12784] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/31/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C) share many symptoms but underlying mechanisms may be different. We have developed a magnetic resonance imaging (MRI) technique to measure intestinal volumes, transit, and motility in response to a laxative, Moviprep(®) . We aim to use these biomarkers to study the pathophysiology in IBS-C and FC. METHODS Twenty-four FC and 24 IBS-C were studied. Transit was assessed using the weighted average position score (WAPS) of five MRI marker pills, taken 24 h before MRI scanning. Following baseline scan, participants ingested 1 L of Moviprep(®) followed by hourly scans. Magnetic resonance imaging parameters and bowel symptoms were scored from 0 to 4 h. KEY RESULTS Weighted average position score for FC was 3.6 (2.5-4.2), significantly greater than IBS-C at 2.0 (1.5-3.2), p = 0.01, indicating slower transit for FC. Functional constipation showed greater fasting small bowel water content, 83 (63-142) mL vs 39 (15-70) mL in IBS-C, p < 0.01 and greater ascending colon volume (AC), 314 (101) mL vs 226 (71) mL in IBS-C, p < 0.01. FC motility index was lower at 0.055 (0.044) compared to IBS-C, 0.107 (0.070), p < 0.01. Time to first bowel movement following ingestion of Moviprep(®) was greater for FC, being 295 (116-526) min, compared to IBS-C at 84 (49-111) min, p < 0.01, and correlated with AC volume 2 h after Moviprep(®) , r = 0.44, p < 0.01. Using a cut-off >230 min distinguishes FC from IBS-C with low sensitivity of 55% but high specificity of 95%. CONCLUSION & INFERENCES Our objective MRI biomarkers allow a distinction between FC and IBS-C.
Collapse
Affiliation(s)
- C. Lam
- NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK
| | - G. Chaddock
- Sir Peter Mansfield Imaging CentreUniversity of NottinghamNottinghamUK
| | - L. Marciani
- NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK
| | - C. Costigan
- NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK
| | - J. Paul
- Sir Peter Mansfield Imaging CentreUniversity of NottinghamNottinghamUK
| | - E. Cox
- Sir Peter Mansfield Imaging CentreUniversity of NottinghamNottinghamUK
| | - C. Hoad
- NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK,Sir Peter Mansfield Imaging CentreUniversity of NottinghamNottinghamUK
| | - A. Menys
- Centre for Medical ImagingDivision of MedicineUniversity College LondonLondonUK
| | - S. Pritchard
- Sir Peter Mansfield Imaging CentreUniversity of NottinghamNottinghamUK
| | - K. Garsed
- Royal Derby Hospitals Foundation TrustDerbyUK
| | - S. Taylor
- Centre for Medical ImagingDivision of MedicineUniversity College LondonLondonUK
| | - D. Atkinson
- Centre for Medical ImagingDivision of MedicineUniversity College LondonLondonUK
| | - P. Gowland
- Sir Peter Mansfield Imaging CentreUniversity of NottinghamNottinghamUK
| | - R. Spiller
- NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK
| |
Collapse
|
2
|
Marciani L, Garsed KC, Hoad CL, Fields A, Fordham I, Pritchard SE, Placidi E, Murray K, Chaddock G, Costigan C, Lam C, Jalanka-Tuovinen J, De Vos WM, Gowland PA, Spiller RC. Stimulation of colonic motility by oral PEG electrolyte bowel preparation assessed by MRI: comparison of split vs single dose. Neurogastroenterol Motil 2014; 26:1426-36. [PMID: 25060551 PMCID: PMC4321061 DOI: 10.1111/nmo.12403] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most methods of assessing colonic motility are poorly acceptable to patients. Magnetic resonance imaging (MRI) can monitor gastrointestinal motility and fluid distributions. We predicted that a dose of oral polyethylene glycol (PEG) and electrolyte solution would increase ileo-colonic inflow and stimulate colonic motility. We aimed to investigate the colonic response to distension by oral PEG electrolyte in healthy volunteers (HVs) and to evaluate the effect of single 2 L vs split (2 × 1 L) dosing. METHODS Twelve HVs received a split dose (1 L the evening before and 1 L on the study day) and another 12 HVs a single dose (2 L on the main study day) of PEG electrolyte. They underwent MRI scans, completed symptom questionnaires, and provided stool samples. Outcomes included small bowel water content, ascending colon motility index, and regional colonic volumes. KEY RESULTS Small bowel water content increased fourfold from baseline after ingesting both split (p = 0.0010) and single dose (p = 0.0005). The total colonic volume increase from baseline was smaller for the split dose at 35 ± 8% than for the single dose at 102 ± 27%, p = 0.0332. The ascending colon motility index after treatment was twofold higher for the single dose group (p = 0.0103). CONCLUSIONS & INFERENCES Ingestion of 1 and 2 L PEG electrolyte solution caused a rapid increase in the small bowel and colonic volumes and a robust rise in colonic motility. The increase in both volumes and motility was dose dependent. Such a challenge, being well-tolerated, could be a useful way of assessing colonic motility in future studies.
Collapse
Affiliation(s)
- L Marciani
- Nottingham Digestive Diseases Centre and NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of NottinghamNottingham, UK,# Joint first author
| | - K C Garsed
- Nottingham Digestive Diseases Centre and NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of NottinghamNottingham, UK,# Joint first author
| | - C L Hoad
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - A Fields
- Nottingham Digestive Diseases Centre and NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of NottinghamNottingham, UK
| | - I Fordham
- Nottingham Digestive Diseases Centre and NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of NottinghamNottingham, UK
| | - S E Pritchard
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - E Placidi
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - K Murray
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - G Chaddock
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - C Costigan
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - C Lam
- Nottingham Digestive Diseases Centre and NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of NottinghamNottingham, UK
| | - J Jalanka-Tuovinen
- Department of Veterinary Biosciences, University of HelsinkiHelsinki, Finland
| | - W M De Vos
- Department of Veterinary Biosciences, University of HelsinkiHelsinki, Finland,Laboratory of Microbiology, Wageningen UniversityWageningen, The Netherlands
| | - P A Gowland
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - R C Spiller
- Nottingham Digestive Diseases Centre and NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of NottinghamNottingham, UK
| |
Collapse
|
3
|
Chaddock G, Lam C, Hoad CL, Costigan C, Cox EF, Placidi E, Thexton I, Wright J, Blackshaw PE, Perkins AC, Marciani L, Gowland PA, Spiller RC. Novel MRI tests of orocecal transit time and whole gut transit time: studies in normal subjects. Neurogastroenterol Motil 2014; 26:205-14. [PMID: 24165044 PMCID: PMC4285997 DOI: 10.1111/nmo.12249] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/23/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colonic transit tests are used to manage patients with Functional Gastrointestinal Disorders. Some tests used expose patients to ionizing radiation. The aim of this study was to compare novel magnetic resonance imaging (MRI) tests for measuring orocecal transit time (OCTT) and whole gut transit time (WGT), which also provide data on colonic volumes. METHODS 21 healthy volunteers participated. Study 1: OCTT was determined from the arrival of the head of a meal into the cecum using MRI and the Lactose Ureide breath test (LUBT), performed concurrently. Study 2: WGT was assessed using novel MRI marker capsules and radio-opaque markers (ROMs), taken on the same morning. Studies were repeated 1 week later. KEY RESULTS OCTT measured using MRI and LUBT was 225 min (IQR 180-270) and 225 min (IQR 165-278), respectively, correlation r(s) = 0.28 (ns). WGT measured using MRI marker capsules and ROMs was 28 h (IQR 4-50) and 31 h ± 3 (SEM), respectively, correlation r(s) = 0.85 (p < 0.0001). Repeatability assessed using the intraclass correlation coefficient (ICC) was 0.45 (p = 0.017) and 0.35 (p = 0.058) for MRI and LUBT OCTT tests. Better repeatability was observed for the WGT tests, ICC being 0.61 for the MRI marker capsules (p = 0.001) and 0.69 for the ROM method (p < 0.001) respectively. CONCLUSIONS & INFERENCES The MRI WGT method is simple, convenient, does not use X-ray and compares well with the widely used ROM method. Both OCTT measurements showed modest reproducibility and the MRI method showed modest inter-observer agreement.
Collapse
Affiliation(s)
- G Chaddock
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - C Lam
- Nottingham Digestive Diseases Centre, School of Medicine, University of NottinghamNottingham, UK,Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of NottinghamNottingham, UK
| | - C L Hoad
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - C Costigan
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - E F Cox
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - E Placidi
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - I Thexton
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - J Wright
- GI Surgery, Nottingham University HospitalsNottingham, UK
| | - P E Blackshaw
- Medical Physics & Clinical Engineering, Nottingham University HospitalsNottingham, UK
| | - A C Perkins
- Medical Physics & Clinical Engineering, Nottingham University HospitalsNottingham, UK,Radiological & Imaging Sciences, School of Medicine, University of NottinghamNottingham, UK
| | - L Marciani
- Nottingham Digestive Diseases Centre, School of Medicine, University of NottinghamNottingham, UK,Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of NottinghamNottingham, UK
| | - P A Gowland
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of NottinghamNottingham, UK
| | - R C Spiller
- Nottingham Digestive Diseases Centre, School of Medicine, University of NottinghamNottingham, UK,Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, University of NottinghamNottingham, UK,Prof Robin C. Spiller, Nottingham Digestive Diseases Biomedical Research Unit, Queen's Medical Centre, E Floor, West Block, Nottingham University Hospitals, University of Nottingham, Nottingham NG7 2UH, UK., Tel: +44 (0) 115 8231090; fax: +44 (0) 115 8231409; e-mail:
| |
Collapse
|