BACKGROUND Wireless pH and pressure motility capsule (wireless motility capsule) technology provides a method to assess regional gastrointestinal transit times. AIMS Data from a multi-center study of gastroparetic patients and healthy controls was analyzed to: compare regional transit times measured by wireless motility capsule in healthy controls and gastroparetics (GP). METHODS 66 healthy controls and 34 patients with GP [15 diabetic and 19 idiopathic] swallowed wireless motility capsule together with standardized meal (255 kcal). Gastric emptying time (GET), small bowel transit time (SBTT), colon transit time (CTT), and whole gut transit time (WGTT) were calculated using the wireless motility capsule. RESULTS GET, CTT and WGTT but not SBTT were significantly longer in GP than in controls. Eighteen percent of gastroparetic patients had delayed WGTT. Both diabetic and idiopathic etiologies of gastroparetics had significantly slower WGTT (p<0.0001) in addition to significantly slower GET than healthy controls. Diabetic gastroparetics additionally had significantly slower CTT than healthy controls (p = 0.0054). CONCLUSIONS 1) In addition to assessing gastric emptying, regional transit times can be measured using wireless motility capsule. 2) The prolongation of CTT in gastroparetic patients indicates dysmotility beyond the stomach in GP is present and could be contributing to symptom presentation.

It has been more than 25 years since Mycobacterium paratuberculosis was first proposed as an etiologic agent in Crohn's disease based on the isolation of this organism from several patients. Since that time, a great deal of information has been accumulated that clearly establishes an association between M. paratuberculosis and Crohn's disease. However, data are conflicting and difficult to interpret and the field has become divided into committed advocates and confirmed skeptics. This review is an attempt to provide a thorough and objective summary of current knowledge from both basic and clinical research from the views and interpretations of both the antagonists and proponents. The reader is left to draw his or her own conclusions related to the validity of the issues and claims made by the opposing views and data interpretations. Whether M. paratuberculosis is a causative agent in some cases or simply represents an incidental association remains a controversial topic, but current evidence suggests that the notion should not be so readily dismissed. Remaining questions that need to be addressed in defining the role of M. paratuberculosis in Crohn's disease and future implications are discussed.

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