Assessment of Whole Gut Motility in Adolescents Using the Wireless Motility Capsule Test

AbstractFunctional gastrointestinal (GI) disorders are often associated with intestinal dysmotility representing a diagnostic challenge. A relatively new method is the wireless motility capsule (WMC) test, which continuously measures pH, pressure, temperature and regional transit times as it passes through the GI tract. In adults, the WMC test was approved for use in the diagnosis of gastroparesis and constipation by assessing GI transit and contractility. We performed the WMC test in nine adolescent patients aged 12–17 years with functional GI symptoms from July 2017 until February 2019. Abnormal transit times were detected in four patients. Three patients showed abnormal transit times of the upper GI tract: in two cases, contractility analysis revealed prolonged gastric retention, and in one patient, abnormal colonic transit was detected.Conclusion: The WMC test is a minimally invasive procedure with potential to expand future diagnostic opportunities for paediatric patients with functional GI disorders and suspected motility disturbances. What is Known:• The assessment of GI transit and contractility of the whole gut is possible with the WMC test which is approved for use in the diagnosis of gastroparesis and constipation in adults. What is New:• The WMC test is a non-invasive diagnostic tool with the potential to expand diagnostic opportunities in paediatric patients by assessing regional and whole gut motility.• In paediatric patients with functional GI disorders, the WMC test could help to make an adequate diagnosis and initiate appropriate therapy.

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Investigation of oral, gastric, and duodenal microbiota in patients with upper gastrointestinal symptoms

Journal of Investigative Medicine ◽

10.1136/jim-2020-001642 ◽

2020 ◽

Vol 69 (4) ◽

pp. 870-877

Author(s):

Jorge Cervantes ◽

Majd Michael ◽

Bo-Young Hong ◽

Aden Springer ◽

Hua Guo ◽

...

Keyword(s):

Gastrointestinal Symptoms ◽

Microbiota Composition ◽

Gi Tract ◽

Upper Gi ◽

Functional Gi Disorders ◽

Gi Symptoms ◽

Dyspeptic Symptoms ◽

Upper Gastrointestinal Symptoms ◽

Upper Gastrointestinal ◽

Gastric Microbiota

Disease-associated alterations of the intestinal microbiota composition, known as dysbiosis, have been well described in several functional gastrointestinal (GI) disorders. Several studies have described alterations in the gastric microbiota in functional dyspepsia, but very few have looked at the duodenum.Here, we explored the upper GI tract microbiota of inpatients with upper GI dyspeptic symptoms, and compared them to achalasia controls, as there is no indication for an esophagogastroduodenoscopy in healthy individuals.We found differences in the microbiota composition at the three sites evaluated (ie, saliva, stomach and duodenum). Changes observed in patients with dyspepsia included an increase in Veillonella in saliva, an oral shift in the composition of the gastric microbiota, and to some degree in the duodenum as well, where an important abundance of anaerobes was observed. Metabolic function prediction identified greater anaerobic metabolism in the stomach microbial community of patients with dyspepsia. Proton pump inhibitor use was not associated with any particular genus. Co-abundance analysis revealed Rothia as the main hub in the duodenum, a genus that significantly correlated with the relative abundance of Clostridium, Haemophilus, and Actinobacillus.We conclude that patients with upper GI symptoms consistent with dyspepsia have alterations in the microbiota of saliva, the stomach, and duodenum, which could contribute to symptoms of functional GI disorders.

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Gastrointestinal Involvement in Mantle Cell Lymphoma (MCL). A Prospective Clinical, Endoscopical, Pathological and Molecular Study.

Blood ◽

10.1182/blood.v106.11.4665.4665 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4665-4665

Author(s):

Antonio Salar ◽

Nuria Juanpere ◽

Eva Gonzalez-Barca ◽

Beatriz Bellosillo ◽

Blanca Espinet ◽

...

Keyword(s):

Cyclin D1 ◽

Molecular Study ◽

Normal Mucosa ◽

Microscopic Level ◽

Gi Tract ◽

Upper Gi ◽

Multiple Biopsies ◽

Gi Symptoms ◽

Lower Endoscopy ◽

Almost All

Abstract Objective: to investigate the clinical, endoscopical, microscopical and molecular involvement of the GI tract in a prospective series of MCL. Methods: 13 patients with MCL have been prospectively and consecutively entered in a staging workup that included upper and lower endoscopy of the GI tract. Multiple biopsies of the stomach and colon were taken from pathologic mucosa and also from macroscopically normal mucosa. Specimens were assessed with immunohistochemistry (IHC), FISH and PCR. Results: Only 1 patient presented with GI symptoms at diagnosis. Endoscopy: Upper GI: abnormal mucosa in 5 cases (38%); Lower GI: abnormal mucosa in 6 cases (45%): mild colitis in 1, multiple micropolyps in 3, a large polyp and multiple micropolyps in 1 and three large polyps with normal mucosa in 1. As a whole, 9 patients (70%) had upper or lower endoscopic findings. Pathology: 10 cases (77%) had microscopic infiltration by MCL of the upper GI tract and 10 cases (77%) of the lower GI tract. As a whole, all but one patient (92%) were found to have microscopic infiltration of the GI tract. All positive cases for CD20 and CD5 were positive for cyclin D1. The PCR product showed a clear monoclonal peak in 12 out of 19 samples, giving a sensitivity of 63.5% compared with IHC. FISH was positive in 7 out of 11 samples (sensitivity of 64% compared with IHC). All but one case with endoscopic abnormalities had GI microscopic infiltration by MCL and 67% of cases with normal endoscopy were found to have GI tract infiltration by MCL. Conclusions: In our series, GI involvement by MCL was detected in almost all patients. All patients with endoscopic abnormalities had infiltration by MCL at the microscopic level. In 2/3 of the patients with normal endoscopy, GI tract involvement could be demonstrated at the microscopic level. IHC with cyclin D1 was more efficient than FISH and PCR as a diagnostic tool in this setting.

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901 Wireless Motility Capsule vs. Antroduodenal Manometry: Diagnostic Comparison in Pediatric Patients With Upper GI Symptoms

Gastroenterology ◽

10.1016/s0016-5085(12)60597-6 ◽

2012 ◽

Vol 142 (5) ◽

pp. S-158

Author(s):

Jaime Belkind-Gerson ◽

Alex Green ◽

Brian C. Surjanhata ◽

Braden Kuo ◽

Hayat Mousa ◽

...

Keyword(s):

Pediatric Patients ◽

Upper Gi ◽

Gi Symptoms ◽

Wireless Motility Capsule ◽

Antroduodenal Manometry

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Rectal bleeding

Oxford Cases in Medicine and Surgery ◽

10.1093/oso/9780198716228.003.0027 ◽

2015 ◽

Author(s):

Hugo Farne ◽

Edward Norris-Cervetto ◽

James Warbrick-Smith

Keyword(s):

Differential Diagnosis ◽

Rectal Bleeding ◽

Haemodynamic Instability ◽

Rapid Transit ◽

Gi Tract ◽

Bacterial Oxidation ◽

Upper Gi ◽

Transit Times ◽

Wine Glass ◽

Acute Patients

As with all acute patients, always start by assessing ABCDE: airways, breathing, circulation, disability, and exposure. In a patient with acute gastrointestinal (GI) haemorrhage (whether upper or lower), assessing their circulation (i.e. haemodynamic status) is a priority. If there are clinical features to suggest haemodynamic instability—such as hypotension, tachycardia, cool peripheries, tachypnoea, or decreased consciousness—then the immediate priority is to resuscitate the patient before proceeding to a thorough history and examination. The differential diagnosis for rectal bleeding is shown in Figure 21.1. There are a couple of points to note about this differential diagnosis. GI haemorrhage may present as overt or occult bleeding. This table, and the indications of prevalence within it, refers to overt rectal bleeding as occult rectal bleeding will not be noticed by the patient. The second point to note is that upper GI sources of haemorrhage may occasionally present with rectal bleeding alone. Although it is more likely that such upper GI sources will also present with haematemesis, you should note that large volumes of blood in the GI tract can act as a cathartic (stimulant of peristalsis) and the resultant rapid transit through the intestine leads to the passage of red blood per rectum. • How much blood has been passed? This question is directly relevant to your initial haemodynamic status survey. Ask the patient to quantify approximately how much blood they have passed—familiar measures such as a teaspoon, eggcup, or wine glass may be easier for the patient than asking them to provide an estimate in millilitres. Note, however, that it is very easy to overestimate volumes of blood loss if, for example, blood has mixed with water in the toilet bowl. You should additionally enquire about symptoms of hypovolaemia—any light-headedness, collapse, chest pain or breathlessness? • What is the duration and frequency of the symptoms? • What did the blood look like? Generally speaking, the fresher the blood, the more distal the bleed. Substantial bleeding from lesions proximal in the GI tract may present with melaena (jet black, tarry stool caused by bacterial oxidation of haem) or may present as frank blood (haematochezia) if transit times are sufficiently rapid.

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INTERVENTIONAL TRAINING MODEL FOR FLEXIBLE ENDOSCOPY IN POSTOPERATIVELY ALTERED ANATOMY OF THE UPPER GI TRACT

10.1055/s-0040-1704783 ◽

2020 ◽

Author(s):

K Koch ◽

U Schweizer ◽

B Mothes ◽

D Wichmann ◽

KE Grund

Keyword(s):

Training Model ◽

Flexible Endoscopy ◽

Gi Tract ◽

Upper Gi ◽

Upper Gi Tract

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Enterogastric Reflux: an Uncommon Diagnosis Analyzed by Hepatobiliary Imaging

Journal of Case Reports in Medicine ◽

10.25149/jcrm.v8i2.178 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Peter Wang

Keyword(s):

Abdominal Pain ◽

Digestive Enzymes ◽

Gallbladder Disease ◽

Hepatobiliary Scintigraphy ◽

Hepatobiliary Imaging ◽

Upper Gi ◽

Gi Symptoms ◽

Upper Abdominal ◽

Enterogastric Reflux

Enterogastric reflux (EGR) is the reflux of bile and digestive enzymes from the small bowel into the stomach. While it is a normal physiologic process in small amounts, excessive reflux and chronic EGR can cause upper GI symptoms often mimicking more common diseases such as gallbladder disease and GERD that often leads to its underdiagnosis. Identifying EGR is significant as it has been associated with the development of gastroesophogeal pathology including gastritis, esophagitis, ulcers, and mucosal metaplasia. This article presents a 22-year-old male with enterogastric reflux causing upper abdominal pain and will discuss the role of hepatobiliary scintigraphy in its diagnosis.

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