Review article: the assessment and management of chronic severe gastrointestinal dysmotility in adults

Paine, Peter; McLaughlin, John; Lal, Simon

doi:10.1111/apt.12496

Cited by 41 publications

(58 citation statements)

References 233 publications

(257 reference statements)

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“…1 The reference standard for small bowel motility assessment is antroduodenal manometry. 1 The reference standard for small bowel motility assessment is antroduodenal manometry.…”

Section: Introductionmentioning

confidence: 99%

Assessment of fasted and fed gastrointestinal contraction frequencies in healthy subjects using continuously tagged MRI

Jonge

Sprengers

Rijn

et al. 2019

Neurogastroenterology Motil

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Background: Continuously tagged MRI during free breathing can assess bowel motility at frequencies as low as the slow wave, motility pattern range. This study aimed to evaluate noninvasive gastrointestinal-tagged MRI for small bowel motility assessment and to observe the physiological response to a 300-kcal meal challenge in healthy, overnight-fasted volunteers.Methods: After overnight fasting, 16 healthy subjects (7 women, mean age 25.5, range 19-37 years) underwent a free breathing, tagged MRI scan to capture small bowel motility. Each subject underwent a (a) baseline motility scan, (b) food challenge, (c) postchallenge scan, and (d) second postchallenge scan (after 20 minutes).Motility was quantified using a frequency analysis technique for measuring the spectral power of the strain, referred to as motility score. Motility score was assessed in 20 frequency intervals between 1 and 20 contractions per minute (cpm), and the data were analyzed with linear mixed-effect models. Key Result:The stimulation protocol demonstrated an immediate, food-induced, motility response in the low-frequency range (2-10 cpm), which is consistent with the stomach and small bowel frequency range (3-12 cpm). Conclusions and Inferences:This study shows that this MRI tagging technique is able to quantify the fasted-to-fed response to a 300-kcal meal challenge within the specific small bowel motility frequency range in healthy subjects. The food provocation MRI protocol provides a tool to explore the gut's response to a stimulus in specific motility frequency ranges in patients with gastrointestinal dysmotility and functional disorders. K E Y W O R D Sdynamic MRI, food challenge, motility, small bowel, SPAMM-tagged MRI This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…1 The reference standard for small bowel motility assessment is antroduodenal manometry. 1 The reference standard for small bowel motility assessment is antroduodenal manometry.…”

Section: Introductionmentioning

confidence: 99%

Assessment of fasted and fed gastrointestinal contraction frequencies in healthy subjects using continuously tagged MRI

Jonge

Sprengers

Rijn

et al. 2019

Neurogastroenterology Motil

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“…Many factors, such as inflammation, inhibitory agents, and neurogenic reflexes, are involved in the development and progression of intestinal dysmotility in various diseases [8][9][10][11]. Among these factors, intestinal inflammation plays an important role in the pathogenesis of intestinal dysmotility [12,13].…”

Section: Discussionmentioning

confidence: 99%

Chronic Kidney Disease Elicits an Intestinal Inflammation Resulting in Intestinal Dysmotility Associated with the Activation of Inducible Nitric Oxide Synthesis in Rat

et al. 2018

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This study was conducted to investigate whether chronic kidney disease (CKD) affects intestinal inflammation and intestinal motility and the underlying mechanisms. Rats were randomized into control group and uremic group. Uremia rats were induced by the 5/6 kidney resection, while the control went through the same procedures but without any kidney resection. Intestinal motility was assessed by charcoal transport assay; intestinal inflammation was assessed by analyses of levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 in the ileum tissue. The inducible nitric oxide synthesis (iNOS) activity was assessed in the ileum tissue. The results showed that the intestinal motility in uremic group was significantly decreased compared with that in the control group on postoperative weeks 8 and 10. Meanwhile, the uremic group presented significantly higher concentrations of TNF-α, IL-6, and IL-10 than control group on postoperative weeks 8 and/or 10, and higher gene expression on postoperative weeks 6, 8, and 10. Furthermore, the intestinal iNOS activity in the uremic group was significantly increased compared with that in control group on postoperative weeks 8 and 10. These results suggest that CKD could induce intestinal inflammation and lead to intestinal dysmotility, which may be associated with iNOS activation in the intestine.

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“…Hospital databases were screened for eligible patients with GID and were checked by the consultant clinical psychologist (JA) and lead consultants (SL, PP) against the inclusion/exclusion criteria. Participants were eligible if they had a diagnosis of severe GID, were fluent in English, and were aged 18 or more. Patients were excluded if insufficiently well to give consent or participate.…”

Section: Methodsmentioning

confidence: 99%

“…Gastrointestinal dysmotility (GID) has no universally accepted definition, but it is a broad term that encompasses a spectrum of disorders where there is dysregulation of the brain‐gut axis or disruption of the complex enteric neuromuscular co‐ordination necessary for motility of food through the gastrointestinal tract . The majority of patients with functional gastrointestinal disorders can be localized and classified according to Rome criteria.…”

Section: Introductionmentioning

confidence: 99%

“…At present, there is no cure for most causes of severe GID; therefore, the focus is primarily on symptom management, limiting risks such as malnutrition through pharmacologic, nutritional, and surgical approaches . There are often challenges managing pain in this population, who frequently run into problems with negative effects of opiate prescribing . In those with severe GID leading to chronic intestinal failure, it may involve futile surgeries associated with high morbidity and mortality rates and in selected cases intestinal transplantation, recurrent hospitalization, and parenteral nutrition (PN, where nutrients are delivered directly into the blood stream) .…”

Section: Introductionmentioning

confidence: 99%

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Gastrointestinal dysmotility: A qualitative exploration of the journey from symptom onset to diagnosis

Twist

Ablett

Wearden

et al. 2018

Neurogastroenterology Motil

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Review article: the assessment and management of chronic severe gastrointestinal dysmotility in adults

Abstract: SUMMARY BackgroundThe characterisation and management of chronic severe gastrointestinal (GI) dysmotility are challenging. It may cause intestinal failure requiring home parenteral nutrition (HPN).

Cited by 41 publications

References 233 publications

Assessment of fasted and fed gastrointestinal contraction frequencies in healthy subjects using continuously tagged MRI

Assessment of fasted and fed gastrointestinal contraction frequencies in healthy subjects using continuously tagged MRI

Chronic Kidney Disease Elicits an Intestinal Inflammation Resulting in Intestinal Dysmotility Associated with the Activation of Inducible Nitric Oxide Synthesis in Rat

Gastrointestinal dysmotility: A qualitative exploration of the journey from symptom onset to diagnosis

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