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Findings in patients with chronic intestinal dysmotility investigated by capsule endoscopy

Hoog CM, Lindberg G, Sjoqvist U - BMC Gastroenterol (2007)

Bottom Line: Mucosal breaks (erosions and ulcerations) were found in 16/18 (89%) patients.The difference in transit time was not significant (p = 0.061) in this material.The relevance of observed mucosal abnormalities in CID remains uncertain.

Affiliation: Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden. charlotte.hoog@sodersjukhuset.se

ABSTRACT

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.

Erosion. Erosion in the small intestine, detected by capsule endoscopy in a patient with chronic intestinal dysmotility and large amounts of intestinal content.
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Figure 1: Erosion. Erosion in the small intestine, detected by capsule endoscopy in a patient with chronic intestinal dysmotility and large amounts of intestinal content.

Mentions: Mucosal breaks were found in 16/18 (89%) patients and in seven patients there were multiple lesions (three or more). The mucosal breaks were divided into erosions and ulcerations. The findings defined as erosions included not only redness but also some loss of mucosa (Figure 1) and often could a small fibrin clot be seen. Ulcerations, on the other hand, were larger, deeper and covered with fibrin (Figure 2). Erosions were the dominating type of mucosal breaks that was found. At most, one patient had 19 erosions. In patient #17, eight ulcerations were found. This patient, however, was found to have used NSAIDs during the period before CE examination. The exact size and localization of lesions are not possible to determine by means of CE and subsequently not in this study group either.

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Findings in patients with chronic intestinal dysmotility investigated by capsule endoscopy

Hoog CM, Lindberg G, Sjoqvist U - BMC Gastroenterol (2007)

Erosion. Erosion in the small intestine, detected by capsule endoscopy in a patient with chronic intestinal dysmotility and large amounts of intestinal content.
© Copyright Policy - open-access
Figure 1: Erosion. Erosion in the small intestine, detected by capsule endoscopy in a patient with chronic intestinal dysmotility and large amounts of intestinal content.
Mentions: Mucosal breaks were found in 16/18 (89%) patients and in seven patients there were multiple lesions (three or more). The mucosal breaks were divided into erosions and ulcerations. The findings defined as erosions included not only redness but also some loss of mucosa (Figure 1) and often could a small fibrin clot be seen. Ulcerations, on the other hand, were larger, deeper and covered with fibrin (Figure 2). Erosions were the dominating type of mucosal breaks that was found. At most, one patient had 19 erosions. In patient #17, eight ulcerations were found. This patient, however, was found to have used NSAIDs during the period before CE examination. The exact size and localization of lesions are not possible to determine by means of CE and subsequently not in this study group either.

Bottom Line: Mucosal breaks (erosions and ulcerations) were found in 16/18 (89%) patients.The difference in transit time was not significant (p = 0.061) in this material.The relevance of observed mucosal abnormalities in CID remains uncertain.

Affiliation: Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden. charlotte.hoog@sodersjukhuset.se

ABSTRACT

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.

View Similar Images In: Results  - Collection
View Article: PubMed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=1940016&rFormat=json&query=null&req=5