Chronic Intestinal Dysmotility Patients Investigated by Capsule Endoscopy
Chronic Intestinal Dysmotility Patients Investigated by Capsule Endoscopy
Background: Capsule endoscopy (CE) is a unique tool to visualize the mucosa of the small intestine. Chronic intestinal dysmotility (CID) is a group of rare disorders of gastrointestinal motility that often are complicated by bacterial overgrowth. The aim of this study was to determine the prevalence of small bowel mucosal abnormalities in patients with CID. We also studied the usefulness of CE in the diagnosis of intestinal dysmotility.
Methods: We conducted a prospective study using CE in 18 patients; six with myopathic, 11 with neuropathic and one with indeterminate CID. A control group was used for comparison of small bowel transit.
Results: Mucosal breaks (erosions and ulcerations) were found in 16/18 (89%) patients. The capsule reached the caecum in 11/18 (61%) patients with a median transit time of 346 minutes. In the control group the capsule reached the caecum in 29/36 (81%) cases with a median transit time of 241 minutes. The difference in transit time was not significant (p = 0.061) in this material. The capsule was retained in the stomach in 3/18 patients. None of the patients developed symptoms or signs of mechanical obstruction.
Conclusion: A high frequency of mucosal breaks and signs of motility disturbances were seen in CID patients. CE is feasible for the examination of small bowel mucosa in patients with CID. The relevance of observed mucosal abnormalities in CID remains uncertain.
Chronic intestinal dysmotility (CID) is a syndrome that is characterized by symptoms and signs of intestinal obstruction in the absence of a mechanical blockage. CID is caused by abnormalities in the intestinal smooth muscle or the myenteric plexus, usually affecting selectively one of them. The underlying pathology in CID is thus believed to comprise two major types: myopathic and neuropathic disorders, although they usually present with similar clinical manifestations. There is considerable confusion regarding the nomenclature in gastrointestinal motility disorders. Patients with CID can also be divided into those with chronic intestinal pseudo-obstruction (CIP) and those with enteric dysmotility (ED). At present the possible medical or surgical treatment for this complex and often debilitating syndrome is limited.
Wireless capsule endoscopy (CE) is a method to examine the mucosa of the small intestine. The patient swallows a small capsule containing a video camera that takes two frames per second during its journey through the gastrointestinal tract. It is propelled by peristalsis and disposable. This method, first described by Iddan et al, is now widespread and has revolutionized the visualisation of small intestinal mucosa.
Previously CID has been considered a contraindication for CE. In the literature there is only one published original article where capsule endoscopy has been performed in patients with CID. In this study six patients were examined and found to have a high frequency of mucosal breaks. The knowledge of the appearance of the mucosa in vivo in this condition is therefore incomplete and the experience of performing CE in patients with CID seems to be limited.
In this prospective study we examined patients with known CID by means of CE. The primary aim of our study was to evaluate the small bowel mucosa of patients with CID. A secondary aim was to find out if CE, by evaluating small bowel transit and signs of dysmotility, could differentiate the two histopathological types of CID from each other and from a control group.
Background: Capsule endoscopy (CE) is a unique tool to visualize the mucosa of the small intestine. Chronic intestinal dysmotility (CID) is a group of rare disorders of gastrointestinal motility that often are complicated by bacterial overgrowth. The aim of this study was to determine the prevalence of small bowel mucosal abnormalities in patients with CID. We also studied the usefulness of CE in the diagnosis of intestinal dysmotility.
Methods: We conducted a prospective study using CE in 18 patients; six with myopathic, 11 with neuropathic and one with indeterminate CID. A control group was used for comparison of small bowel transit.
Results: Mucosal breaks (erosions and ulcerations) were found in 16/18 (89%) patients. The capsule reached the caecum in 11/18 (61%) patients with a median transit time of 346 minutes. In the control group the capsule reached the caecum in 29/36 (81%) cases with a median transit time of 241 minutes. The difference in transit time was not significant (p = 0.061) in this material. The capsule was retained in the stomach in 3/18 patients. None of the patients developed symptoms or signs of mechanical obstruction.
Conclusion: A high frequency of mucosal breaks and signs of motility disturbances were seen in CID patients. CE is feasible for the examination of small bowel mucosa in patients with CID. The relevance of observed mucosal abnormalities in CID remains uncertain.
Chronic intestinal dysmotility (CID) is a syndrome that is characterized by symptoms and signs of intestinal obstruction in the absence of a mechanical blockage. CID is caused by abnormalities in the intestinal smooth muscle or the myenteric plexus, usually affecting selectively one of them. The underlying pathology in CID is thus believed to comprise two major types: myopathic and neuropathic disorders, although they usually present with similar clinical manifestations. There is considerable confusion regarding the nomenclature in gastrointestinal motility disorders. Patients with CID can also be divided into those with chronic intestinal pseudo-obstruction (CIP) and those with enteric dysmotility (ED). At present the possible medical or surgical treatment for this complex and often debilitating syndrome is limited.
Wireless capsule endoscopy (CE) is a method to examine the mucosa of the small intestine. The patient swallows a small capsule containing a video camera that takes two frames per second during its journey through the gastrointestinal tract. It is propelled by peristalsis and disposable. This method, first described by Iddan et al, is now widespread and has revolutionized the visualisation of small intestinal mucosa.
Previously CID has been considered a contraindication for CE. In the literature there is only one published original article where capsule endoscopy has been performed in patients with CID. In this study six patients were examined and found to have a high frequency of mucosal breaks. The knowledge of the appearance of the mucosa in vivo in this condition is therefore incomplete and the experience of performing CE in patients with CID seems to be limited.
In this prospective study we examined patients with known CID by means of CE. The primary aim of our study was to evaluate the small bowel mucosa of patients with CID. A secondary aim was to find out if CE, by evaluating small bowel transit and signs of dysmotility, could differentiate the two histopathological types of CID from each other and from a control group.