Novel <scp>MRI</scp> tests of orocecal transit time and whole gut transit time: studies in normal subjects

Chaddock, Gemma; Lam, Ching; Hoad, Caroline L.; Costigan, Carolyn; Cox, Eleanor; Placidi, E.; Thexton, I.; Wright, Jeff; Blackshaw, P. E.; Perkins, Alan C.; Marciani, Luca; Gowland, Penny A.; Spiller, Robin C.

doi:10.1111/nmo.12249

Cited by 59 publications

(107 citation statements)

References 35 publications

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“…This can be used to characterize healthy physiology or patient groups 11 or be used in interventional studies. 12 To reduce time expenditure on analysis, semi-automatic and automatic techniques have been developed to determine volumes with MRI, although these are often guided by the use of contrast-enhancing agents, which prevents assessment of resting volume. [13][14][15] We have recently presented a novel MRI-based semi-automatic technique that allows determination of segmental colorectal volumes without the use of contrast-enhancing agents.…”

Section: Introductionmentioning

confidence: 99%

Quantification and variability in colonic volume with a novel magnetic resonance imaging method

Nilsson

Sandberg

Poulsen

et al. 2015

Neurogastroenterology Motil

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Key Messages• The aim of this study was to describe the inter-individual and intra-individual variability in segmental volume of the undisturbed colon between two observations and the effect of defecation on the segmental volumes.• Variability of segmental colorectal volumes was assessed with a novel semi-automatic MRI-based technique in healthy males in a controlled fasting state.• Despite being a highly dynamic organ, the colon displays low intra-individual variability and the technique is sensitive to the changes in segmental colorectal volume that occur from defecation. AbstractBackground Segmental distribution of colorectal volume is relevant in a number of diseases, but clinical and experimental use demands robust reliability and validity. Using a novel semi-automatic magnetic resonance imaging-based technique, the aims of this study were to describe: (i) inter-individual and intra-individual variability of segmental colorectal volumes between two observations in healthy subjects and (ii) the change in segmental colorectal volume distribution before and after defecation. Methods The inter-individual and intra-individual variability of four colorectal volumes (cecum/ ascending colon, transverse, descending, and rectosigmoid colon) between two observations (separated by 52 AE 10) days was assessed in 25 healthy males and the effect of defecation on segmental colorectal volumes was studied in another seven healthy males. Key Results No significant differences between the two observations were detected for any segments (All p > 0.05). Inter-individual variability varied across segments from low correlation in cecum/ascending colon (intra-class correlation coefficient [ICC] = 0.44) to moderate correlation in the descending colon (ICC = 0.61) and high correlation in the transverse (ICC = 0.78), rectosigmoid (ICC = 0.82), and total volume (ICC = 0.85). Overall intra-individual variability was low (coefficient of variance = 9%). After defecation the volume of the rectosigmoid decreased by 44% (p = 0.003). The change in rectosigmoid volume was associated with the true fecal volume (p = 0.02). Conclusions & Inferences Imaging of segmental colorectal volume, morphology, and fecal accumulation is advantageous to conventional methods in its low variability, high spatial resolution, and its absence of contrast-enhancing agents and irradiation. Hence, the method is suitable for future clinical and interventional studies and for characterization of defecation physiology.

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Section: Introductionmentioning

confidence: 99%

Quantification and variability in colonic volume with a novel magnetic resonance imaging method

Nilsson

Sandberg

Poulsen

et al. 2015

Neurogastroenterology Motil

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“…In particular, Chaddock et al measured OCTT using MRI and lactose-ureide breath test, showing poor correlation between these methods when analyzed after administration of a meal (15).…”

Section: Discussionmentioning

confidence: 99%

“…Currently, evaluation of OCTT is challenging because of the important drawbacks of the available techniques (9)(10)(11)(12)(13)(14)(15)(16)(17). LHBT is a simple, non-invasive and widely-used test that provides indirect measurement of OCTT based on the time from lactulose ingestion to metabolism by colonic microbiota and an increase in breath H 2 E; however, it can be confounded by the presence of SIBO and H 2 non-producers (i.e., colonic microbiota that does not produce H 2 ) (10,11,22,23,27).…”

Section: Discussionmentioning

confidence: 99%

“…However routine clinical investigations of GI function are not, at present, able to identify the underlying causes of symptoms and disease (8). Moreover, the evaluation of OCTT is controversial due to important problems of the available techniques, such as lactulose hydrogen breath testing (LHBT), sequential scintigraphy with isotope-marked meals, or by magnetic resonance imaging (MRI) (9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

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Measurement of oro-caecal transit time by magnetic resonance imaging

Savarino¹,

Savarino

Fox

et al. 2015

Eur Radiol

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OBJECTIVES To assess prospectively the agreement of orocaecal transit time (OCTT) measurements by lactulose hydrogen breath test (LHBT) and magnetic resonance imaging (MRI) in healthy subjects. METHODS Volunteers underwent abdominal 1.5-T MRI using axial and coronal single-shot fast-spin-echo T2-weighted sequences, having fasted and after lactulose ingestion (10 g/125 mL). Imaging and H2 excretion gas-chromatography were performed concurrently every 15 min up to 180 min. MR images were analyzed using semiautomatic segmentation to calculate small bowel gas volume (SBGV) and visually to detect bolus arrival in the caecum. Agreement between MRI-and LHBT-OCTT was assessed. RESULTS Twenty-eight subjects (17 men/11 women; mean age ± standard deviation 30 ± 8 years) were evaluated. Two H2 non-producers on LHBT were excluded. OCTT measured by MRI and LHBT was concordant in 18/26 (69 %) subjects (excellent agreement, k = 0.924). Median SBGV was 49.0 mL (interquartile interval 44.1 -51.6 mL). In 8/26 (31 %) subjects, MRI showed that the lactulose bolus was in the terminal ileum and not the caecum when H2E increased on LHBT. Median OCTT measured by MRI was significantly longer than OCTT measured by LHBT [135 min (120 -150 min) vs. 127.5 min (105 -150 min); p = 0.008]. Above baseline levels, correlation between [H2] and SBGV was significant (r = 0.964; p < 0.001). CONCLUSIONS MRI provides valid measurements of OCTT and gas production in the small bowel. KEY POINTS • MRI is a valid technique to measure OCTT. • Excellent agreement between MRI and LHBT was found. • Measuring gas production using MRI may provide evidence of small bowel fermentation. Methods: Volunteers underwent abdominal 1.5-T MRI using axial and coronal single-shot fast-spin-echo T2-weighted sequences in the fasted condition and after lactulose ingestion (10g/125mL). Imaging and H 2 excretion gas-cromatography were performed concurrently every 15 minutes up to 180 minutes. MR images were analyzed using semiautomatic segmentation to calculate small bowel gas volume (SBGV) and visually to detect bolus arrival in the cecum.Agreement between MRI-and LHBT-OCTT was assessed.Results: Twenty-eight subjects (17 males/11 females;mean age±standard deviation 30±8 years) were evaluated. Two H 2 non-producers on LHBT were excluded. OCTT measured by MRI and LHBT was concordant in 18/26 (69%) subjects (excellent agreement,k=0.924). Median SBGV was 49.0 mL (interquartile interval 44.1-51.6 mL). In 8/26 (31%) subjects, MRI showed the lactulose bolus was in the terminal ileum and not the cecum when H 2 E increased on LHBT. Thus, median OCTT measured by MRI was significantly longer than that measured by min)vs.127.5(105-150min);p=0.008]. Above baseline levels, correlation between [H 2 ] and SBGV was significant (r=0.964;p<0.001).Conclusions: MRI provides valid measurements of OCTT and gas production in the small bowel. Keypoints: MRI is a valid technique to measure OCTT.  Excellent agreement between MRI and LHBT was found. Measuring gas production using MRI may pro...

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“…It may well be that the constriction of the small bowel that reduces SBWC does not always lead to faster transit if the CRFinduced motor pattern is nonpropulsive. It is worth noting that this recently validated OCTT test (37) was standardized for use with a solid meal, and it may not be optimal for assessment of transit with an osmotically active liquid meal such as we used. All participants in the study received a standard dose of CRF; it is likely that a dose based on individual weight would have been more appropriate.…”

Section: Figurementioning

confidence: 99%

Corticotropin-releasing factor increases ascending colon volume after a fructose test meal in healthy humans: a randomized controlled trial

Murray

Lam

Rehman

et al. 2016

The American Journal of Clinical Nutrition

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Background: Poorly absorbed fermentable carbohydrates can provoke irritable bowel syndrome (IBS) symptoms by escaping absorption in the small bowel and being rapidly fermented in the colon in some susceptible subjects. IBS patients often are anxious and stressed, and stress accelerates small bowel transit, which may exacerbate malabsorption. Objective: In this study we investigated the effect of an intravenous injection of corticotropin-releasing factor (CRF) on fructose malabsorption and the resulting volume of water in the small bowel. Design: We performed a randomized, placebo-controlled crossover study of CRF compared with saline injection in 11 male and 10 female healthy subjects, examining the effect on the malabsorption of a 40-g fructose test meal and its transit through the gut, which was assessed by serial MRI and breath hydrogen measurement. Orocecal transit was assessed with the use of the lactose [13 C]ureide breath test and the adrenal response to CRF was assessed by serial salivary cortisol measurements. Results: CRF injection caused a significant increase in salivary cortisol, which lasted for 135 min. Small bowel water content (SBWC) rose from baseline, peaking at 45 min after fructose ingestion, whereas breath hydrogen peaked later, at 75 min. The area under the curve for SBWC from 215 min to 135 min was significantly lower after CRF compared with saline [mean difference: 5911 mL $ min (95% CI: 18.4, 11,803 mL $ min), P = 0.049]. Considering all subjects, the percentage change in ascending colon volume rose significantly after CRF. This increase was significant for male (P = 0.026), but not female, volunteers. Conclusions: CRF constricts the small bowel and increases fructose malabsorption, as shown by increased ascending colon volumes. This mechanism may help to explain the increased sensitivity of some stressed individuals to fructose malabsorption. This trial was registered at clinicaltrials.gov as NCT01763281.Am J Clin Nutr 2016;103:1318-26.

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Novel MRI tests of orocecal transit time and whole gut transit time: studies in normal subjects

Cited by 59 publications

References 35 publications

Quantification and variability in colonic volume with a novel magnetic resonance imaging method

Quantification and variability in colonic volume with a novel magnetic resonance imaging method

Measurement of oro-caecal transit time by magnetic resonance imaging

Corticotropin-releasing factor increases ascending colon volume after a fructose test meal in healthy humans: a randomized controlled trial

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