Morpho-functional evaluation of small bowel using wireless motility capsule and video capsule endoscopy in patients with known or suspected Crohn’s disease: pilot study
Abstract:Background and study aims: SmartPill® (Given Imaging Corp.,Yoqneam,Israel) is an ingestible, non-imaging capsule that records physiological data including contractions and pH throughout the gastrointestinal tract. There are scarce data looking at SmartPill® assessment of patients with known/suspected small-bowel Crohn’s Disease (CD). This pilot study aims to investigate feasibility and safety of SmartPill® to assess gut motility in this group.
Patients and methods: Over 1 year, patients with known/suspected C… Show more
“…Our VCE GET values are similar to those of healthy subjects reported by others, including a recent study in which both WMC and VCE were performed in the same healthy subjects on same visit . In the latter paper, mean VCE GET was 73 min (personal communication from D. Yung); mean WMC GET was 250 min.…”
GET, SBTT, CTT and WGTT obtained by WMC are commensurate with literature values, including by other methods. Visually and software derived transit times have strongest correlations for CTT and WGTT. WMC yields longer GET and SBTT than VCE, perhaps due to meal related effects on motility.
“…Our VCE GET values are similar to those of healthy subjects reported by others, including a recent study in which both WMC and VCE were performed in the same healthy subjects on same visit . In the latter paper, mean VCE GET was 73 min (personal communication from D. Yung); mean WMC GET was 250 min.…”
GET, SBTT, CTT and WGTT obtained by WMC are commensurate with literature values, including by other methods. Visually and software derived transit times have strongest correlations for CTT and WGTT. WMC yields longer GET and SBTT than VCE, perhaps due to meal related effects on motility.
“…Recently, Farmer et al 35 stated that WMC testing is contraindicated in IBD patients with known or suspected strictures along the length of the GI tract. However, even more recently, Yung et al 40 reported results from the first pilot study on a morphofunctional evaluation of the small bowel using a WMC and WCE in patients with known or suspected CD. In the respective study, they had administered the PillCam SB2, a WCE, and the SmartPill to 12 CD patients and 33 controls.…”
Section: Acquisition Of Appropriate Gi Transit Profilesmentioning
Drug release and availability at the site of action are the major factors determining the clinical response for locally-acting gastrointestinal (GI) drug products. The present work focused on the prediction of site and extent of in vivo mesalazine release after oral administration to a variety of subjects using individualized in vitro drug release experiments. First, experiments mimicking GI passages in average adult subjects were performed. Then, results from a study screening fasted in vivo pH and transit profiles in individual subjects were translated into a novel in vitro dissolution model enabling to mimic individual GI pH-profiles and transit times with physiologically relevant dissolution media. A selection of monolithic and multiparticulate mesalazine formulations with pH-dependent and pH-independent drug release was screened with the novel dissolution model. Results of the study indicate that dosage form performance can be significantly different in individual subjects and highlight the importance of addressing individual physiological parameters relevant to intraluminal drug release when the aim is to predict the in vivo performance of locally-acting mesalazine formulations in individual patients. The novel in vitro dissolution approach thus represents a valuable tool for both improving individual oral therapy with locally-acting GI drug products and assessing bioequivalence of these formulations.
“…Common symptoms of CD and UC are abdominal pain, diarrhea, and rectal bleeding. Patients with IBD display abnormal motility of the small intestine ( 13 , 14 , 15 , 16 ) and colon ( 17 , 18 , 19 ). Figure 1 Fig.…”
Section: Pathophysiological Features Of Icc In Inflammatory Diseasementioning
The gastrointestinal (GI) tract is a vital organ that digests food, absorbs nutrients,
and excretes waste. Normal GI motility is the basis for these functions. The interstitial
cells of Cajal (ICC) in the GI muscularis layer promote GI motility together with the
enteric nervous system and smooth muscle cells. Since GI motility results from complex
coordination of these heterogeneous cells, failure of any one of them can lead to GI
dysmotility. Knowledge about ICC in physiological conditions has accumulated in recent
decades, while the pathophysiology of ICC in GI inflammatory diseases, such as
inflammatory bowel disease, is not well understood. In this review, we summarize the
previous studies about the pathophysiological changes of ICC in inflammatory diseases and
discuss the inflammatory mediators that induce ICC dysfunction.
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