Ambulatory assessment of colonic motility using the electromagnetic capsule tracking system

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Background The 3D‐Transit electromagnet tracking system (Motilis Medica, SA, Lausanne, Switzerland) is an emerging tool for the ambulatory assessment of gastrointestinal (GI) transit and motility. Using this tool, we aimed to derive normative values for region‐specific colonic and GI transit times and to assess the influence of age, gender, and body mass index (BMI). Methods Regional and total colonic transit times (CTT), gastric emptying (GET), small intestinal (SITT), and whole gut (WGTT) transit times were extracted from 111 healthy volunteers from the United Kingdom and Denmark (58 female; median age: 40 years [range: 21‐88]). The effects of age, gender, and BMI were assessed using standard statistical methods. Key Results The ascending, transverse, descending, and rectosigmoid colon transit times accounted for 32%, 34%, 17%, and 17% of total CTT in females, and 33%, 25%, 14%, and 28% of total CTT in males. CTT and WGTT were seen to cluster at intervals separated by approximately 24 hours, providing further evidence of the non‐continuous nature of these measurements. Increasing age was associated with longer CTT (P = .021), WGTT (P < .001) ascending (P = .004), transverse (P < .001), and total right (P < .001) colon transit times, but shorter rectosigmoid (P = .004) transit time. Female gender was significantly associated with longer transverse (P = .049) and descending (P < .001) colon transit times, but shorter rectosigmoid (P < .001) transit time. Increasing BMI was significantly associated with shorter WGTT (P = .012). Conclusions and Inferences For the first time, normative reference values for region‐specific colonic transit have been presented. Age, gender, and BMI were seen to have an effect on transit times.

“…20,46 In addition, colonic content is known to move both in the antegrade (toward rectum) and retrograde directions. In other words, there is a staccato progression of colonic content.…”

Section: Comparison Of 3d-transit System With Conventional Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Normative values for region‐specific colonic and gastrointestinal transit times in 111 healthy volunteers using the 3D‐Transit electromagnet tracking system: Influence of age, gender, and body mass index

Nandhra

Mark

Tanna

et al. 2019

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“…3D‐Transit recordings provide detailed information on total and regional GI transit times. Recently, further software development for postprocessing of data allows detailed description of movement patterns within the colon …”

Section: Introductionmentioning

confidence: 99%

Ambulatory assessment of colonic motility using the electromagnetic capsule tracking system: Effect of opioids

Mark

Klinge

Grønlund

et al. 2019

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Background Opioid treatment often causes debilitating constipation. However, it is not well described how opioids affect colonic motility and whether opioid‐induced constipation is due to either a decrease of powerful peristaltic contractions or “uncoordinated” peristalsis. The present study aims to investigate the effect of oxycodone on parameters of colonic motility and to determine whether motility is normalized by the opioid antagonist naloxegol. Methods In two randomized, double‐blind crossover trials, oxycodone or placebo was administered to 25 healthy males (Trial A), while another 24 healthy males were administered oxycodone with naloxegol or placebo (Trial B). Colonic motility was assessed by tracking the progression of an electromagnetic capsule throughout the large intestine. Segmental colonic transit times and capsule movements were calculated using displacement distance and velocity. Key Results In Trial A, colonic transit time increased during oxycodone treatment compared with placebo (39 vs 18 hours, P < .01). Displacement during long fast antegrade movements was shorter during oxycodone treatment than with placebo (10 vs 20 cm, P = .03). In Trial B, colonic transit time was faster during oxycodone + naloxegol than during oxycodone + placebo (40 vs 55 hours, P = .049), mainly caused by an increase of the percentwise fraction of distance covered by fast movements in the left colon (P = .001). Conclusion & Inferences Oxycodone treatment impaired colonic motility, manifested as increased transit time, specifically decreased long fast antegrade movements, and addition of naloxegol improved motility dynamics. In humans, the increased transit time during opioid treatment is caused by a decrease in long fast movements rather than uncoordinated peristalsis.

“…The colon is a versatile organ that maintains fluid and electrolyte balance, absorbs nutrients, stores, then eliminates excreta, and provides a harbor for billions of microorganisms, whose contributions to health and disease are increasingly recognized . These diverse functions necessitate complex patterns of colonic storage and transit.…”

Section: Introductionmentioning

confidence: 99%

“…The pH‐pressure capsule also measures colonic pressures. Accompanying an article on the 3D electromagnetic capsule in this issue of the journal, this mini‐review compares the methods for assessing colonic transit. While magnetic resonance imaging can evaluate colonic wall motion, volumes, and transit for short durations, logistical constraints likely preclude the assessment of pan‐colonic transit with magnetic resonance imaging …”

Section: Introductionmentioning

confidence: 99%

More movement with evaluating colonic transit in humans

Bharucha

Anderson

Bouchoucha

2019

Background Colonic functions (ie, absorption of fluids and electrolytes, digestion of selected nutrients, harbor for microbes, and elimination of excreta) necessitate complex patterns of storage and transit. Indeed, colonic transit accounts for a major part of the mouth‐to‐anus transit time. Colonic transit assessments are useful for understanding the pathophysiology of disease, the pharmacodynamic effects of new medications and to diagnose slow transit constipation. Currently, radiopaque markers, scintigraphy, and a colonic pH‐pressure capsule are used to measure overall colonic transit. Radioopaque markers, scintigraphy, and the electromagnetic capsule, which is a newer technique, also evaluate regional colonic transit. The pH‐pressure capsule also measures colonic pressures. Magnetic resonance imaging and a radio‐frequency identification‐based device are evolving methods for assessing colonic transit. Purpose This mini‐review, which accompanies a study evaluating the assessment of colon transit with the electromagnetic capsule, evaluates and compares existing and evolving methods for evaluating colonic transit in humans (Neurogastroenterol Motil. 2018; in press). In addition to overall and regional colonic transit, the electromagnetic capsule evaluates colonic motor patterns without radiation exposure. These patterns are summarized by analyzing the characteristics (ie, distance and velocity) of discrete antegrade and retrograde capsule movements as they travel in the colon. However, the electromagnetic capsule does not measure pressure or colonic wall movement (ie, contractions). The motor patterns identified by this capsule should be compared with motor patterns identified with manometry. The next challenge is to harness different techniques to evaluate the relationships between colonic pressures and transit or, even better, the trifecta of colonic contractions, pressure events, and transit.