Role of wireless motility capsule in the assessment and management of gastrointestinal dysmotility in patients with diabetes mellitus

Rouphael, Carol; Arora, Zubin; Thota, Prashanthi N.; López, Rocío; Santisi, Janice; Funk, Cynthia; Cline, Michael

doi:10.1111/nmo.13087

Cited by 22 publications

(38 citation statements)

References 20 publications

(25 reference statements)

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“…Compared to GES and other methods for evaluating gastric emptying, WMC has the great advantage of examining several GI regions during the same test. This is especially relevant in diabetes patients, often presenting multiregional dysmotility . In contrast to GES, it does not involve radiation and has a universally standardized meal .…”

Section: Discussionmentioning

confidence: 99%

“…This is especially relevant in diabetes patients, often presenting multiregional dysmotility. 5,44 In contrast to GES, it does not involve radiation and has a universally standardized meal. 45 Furthermore, conduction of the test requires little training, transit time results are mostly easy to interpret, and the test equipment is not space consuming.…”

Section: Roc Curvementioning

confidence: 99%

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Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

Sangnes

Søfteland

Bekkelund

et al. 2019

Neurogastroenterology Motil

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Background Gastroparesis is a potentially severe late complication of diabetes mellitus. Today, delayed gastric emptying (GE) is mandatory for establishing the diagnosis. In this study, we compared wireless motility capsule (WMC) with gastric emptying scintigraphy (GES). Methods Seventy‐two patients (49 women) with diabetes mellitus (59 type 1) and symptoms compatible with gastroparesis were prospectively included between 2014 and 2018. Patients were simultaneously examined with GES and WMC. Symptoms were assessed with the Patient Assessment of Upper Gastrointestinal Symptom Severity Index (PAGI‐SYM) questionnaire. All patients were on intravenous glucose‐insulin infusion during testing. Key Results WMC and GES correlated r = .74, P < .001. Compared to GES, WMC at ordinary cutoff for delayed GE (300 minutes) had a sensitivity of 0.92, specificity 0.73, accuracy 0.80, and Cohen's kappa κ = 0.61 (P < .001). By receiver operating characteristics (ROC), the area under the curve was 0.95 (P < .001). A cutoff value for delayed GE of 385 minutes produced sensitivity 0.92, specificity 0.83, accuracy 0.86, and Cohen's kappa κ = 0.72 (P < .001). Inter‐rater reliability for GE time with WMC was r = .996, κ = 0.97, both P < .001. There was no difference in symptom severity between patients with normal and delayed GE. Conclusions & Inferences Our findings demonstrate the applicability of WMC as a reliable test to assess gastric emptying in diabetic gastroparesis showing very high inter‐observer correlation. By elevating the cutoff value for delayed emptying from 300 to 385 minutes, we found higher specificity without reducing sensitivity.

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Section: Discussionmentioning

confidence: 99%

Section: Roc Curvementioning

confidence: 99%

Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

Sangnes

Søfteland

Bekkelund

et al. 2019

Neurogastroenterology Motil

View full text Add to dashboard Cite

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“…There are a set of robust normal values, and its use has been approved by the Food and Drug Administration [ 60 ]. In one study in patients experiencing GI symptoms, 65% had prolonged gastric emptying, 24% had prolonged small intestinal transit time, and 58% had prolonged colon transit time [ 61 ]. The findings mirrored another cohort of adults with diabetes and established sensorimotor neuropathy, where 44% had abnormal transit in one or more segments, independent of symptomatology [ 51 ].…”

Section: Modalities For Assessing Motilitymentioning

confidence: 99%

“…The findings mirrored another cohort of adults with diabetes and established sensorimotor neuropathy, where 44% had abnormal transit in one or more segments, independent of symptomatology [ 51 ]. Therefore, accumulating evidence supports that gastroparesis can coexist with prolonged transit in the small and large bowels as well as low contractility of the colon [ 61 – 63 ]. Beyond pure measurement of transit times, it has recently been proposed that the change in pH across the ileocaecal junction may represent a surrogate marker for caecal fermentation, which itself may influence colonic transit times [ 51 ].…”

Section: Modalities For Assessing Motilitymentioning

confidence: 99%

Diabetic Enteropathy: From Molecule to Mechanism-Based Treatment

Meldgaard

Olesen

Farmer

et al. 2018

Journal of Diabetes Research

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The incidence of the micro- and macrovascular complications of diabetes is rising, mirroring the increase in the worldwide prevalence. Arguably, the most common microvascular complication is neuropathy, leading to deleterious changes in both the structure and function of neurons. Amongst the various neuropathies with the highest symptom burden are those associated with alterations in the enteric nervous system, referred to as diabetic enteropathy. The primary aim of this review is to provide a contemporaneous summary of pathophysiology of diabetic enteropathy thereby allowing a “molecule to mechanism” approach to treatment, which will include 4 distinct aspects. Firstly, the aim is to provide an overview of the diabetes-induced structural remodelling, biochemical dysfunction, immune-mediated alterations, and inflammatory properties of the enteric nervous system and associated structures. Secondly, the aim is to provide a synopsis of the clinical relevance of diabetic enteropathy. Thirdly, the aim is to discuss the various patient-reported outcome measures and the objective modalities for evaluating dysmotility, and finally, the aim is to outline the clinical management and different treatment options that are available. Given the burden of disease that diabetic enteropathy causes, earlier recognition is needed allowing prompt investigation and intervention, which may lead to improvements in quality of life for sufferers.

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“…We read with interest the report by Rouphael et al examining the role of the wireless motility capsule (WMC) in the investigation and management of diabetes. 1 In a group of 100 patients with diabetes, the authors demonstrate that 72% had evidence of dysmotility, of which 59.7% was isolated to a single segment and 40.3% had multisegmental involvement, based on prolongation of transit times.…”

Section: Multiregional Dysmotility In Diabetes Mellitus Assessed Usinmentioning

confidence: 98%

Multiregional dysmotility in diabetes mellitus assessed using the wireless motility capsule

Brock

Drewes

Farmer

2017

Neurogastroenterology Motil

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We read with interest the report by Rouphael et al. examining the role of the wireless motility capsule (WMC) in the investigation and management of diabetes. 1 In a group of 100 patients with diabetes, the authors demonstrate that 72% had evidence of dysmotility, of which 59.7% was isolated to a single segment and 40.3% had multisegmental involvement, based on prolongation of transit times.We have previously published a case-control study in patients with type 1 diabetes that broadly agree with these findings such that there was pan-enteric prolongation of transit times in comparison to healthy controls. 2 These data and ours have important implications as delayed transit may have a negative impact on nutrition and the bioavailability of medications. It is likely that diabetic enteropathy is likely to become more common given the increasing prevalence of diabetes. 3 However, the normal values which the authors use to define normal transit times, apart from gastric emptying time, are incorrect and we presume these were derived from the MotiliGI software that is used to report WMC data that has yet to integrate recent literature. Rouphael et al. define the upper limits for small and large bowel transit as 6 hours and >59 hours respectively whereas Wang et al., demonstrated that 8 hours and 50.5 hours are the upper limits of normal and suggested these should be used in clinical practice. 4 Thus in this report, the authors are overestimating abnormalities in small bowel transit time but underestimating colonic transit times. Clearly, the standardization of interpretation of physiological data is important. A notable success in this regards, with respect to upper GI physiology, is the advent of the Chicago classification. 5 It is arguable that a similar process should be applied to the WMC.The authors did not demonstrate any associations between transit times and demographic/clinical parameters, which is in agreement with a number of other studies. 6 This suggests that the genesis and maintenance of symptoms is beyond purely prolongation in transit times. Hitherto, the majority of studies utilizing the WMC have largely overlooked the pressure data that is derived from the WMC. Notably Barshop et al. reported an association between symptoms and pressure area under the curve (AUC) in the duodenum (rather than gastric). 7 The development of a more complete understanding of the co-relationships between contractility parameters, transit times and symptoms is needed. In future, this could represent a composite therapeutic endpoint for clinical trials.

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Role of wireless motility capsule in the assessment and management of gastrointestinal dysmotility in patients with diabetes mellitus

Abstract: There was no association between hemoglobinA1c levels, microvascular complications and pattern of GI dysmotility in diabetic patients undergoing WMC. WMC testing lead to management changes in approximately 75% of diabetic patients with GI dysmotility.

Cited by 22 publications

References 20 publications

Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

Diabetic Enteropathy: From Molecule to Mechanism-Based Treatment

Multiregional dysmotility in diabetes mellitus assessed using the wireless motility capsule

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