Clinical Gastroenterology and Hepatology
Volume 7, Issue 5 , Pages 537-544, May 2009

Investigation of Colonic and Whole-Gut Transit With Wireless Motility Capsule and Radiopaque Markers in Constipation

  • Satish S.C. Rao

      Affiliations

    • Department of Medicine, University of Iowa, Iowa City, Iowa
    • Corresponding Author InformationReprint requests Address requests for reprints to: Satish S. C. Rao, MD, PhD, FRCP (LON), 4612 JCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1009. fax: (319) 353-6399
    • ,
  • Braden Kuo

      Affiliations

    • Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
    • ,
  • Richard W. McCallum

      Affiliations

    • Department of Medicine, Kansas University Medical Center, Kansas City, Kansas
    • ,
  • William D. Chey

      Affiliations

    • Department of Medicine, University of Michigan, Ann Arbor, Michigan
    • ,
  • John K. DiBaise

      Affiliations

    • Department of Medicine, Mayo Clinic, Scottsdale, Arizona
    • ,
  • William L. Hasler

      Affiliations

    • Department of Medicine, University of Michigan, Ann Arbor, Michigan
    • ,
  • Kenneth L. Koch

      Affiliations

    • The SmartPill Corporation, Buffalo, New York
    • ,
  • Jeffrey M. Lackner

      Affiliations

    • Department of Biostatistics, State University of New York at Buffalo, Buffalo, New York
    • ,
  • Carrie Miller

      Affiliations

    • Department of Biostatistics, State University of New York at Buffalo, Buffalo, New York
    • ,
  • Richard Saad

      Affiliations

    • Department of Medicine, Temple University, Philadelphia, Pennsylvania
    • ,
  • Jack R. Semler

      Affiliations

    • The SmartPill Corporation, Buffalo, New York
    • ,
  • Michael D. Sitrin

      Affiliations

    • Department of Biostatistics, State University of New York at Buffalo, Buffalo, New York
    • ,
  • Gregory E. Wilding

      Affiliations

    • Department of Biostatistics, State University of New York at Buffalo, Buffalo, New York
    • ,
  • Henry P. Parkman

      Affiliations

    • Department of Medicine, University of Iowa, Iowa City, Iowa

published online 05 February 2009.

Background & Aims

Colonic transit time (CTT) traditionally is assessed with radiopaque markers (ROMs), which requires radiation and is hindered by lack of standardization and compliance. We assessed regional and CTT with the SmartPill (SmartPill Corporation, Buffalo, NY), a new wireless pH and pressure recording capsule, in constipated and healthy subjects and compared this with ROM.

Methods

Seventy-eight constipated (Rome II) and 87 healthy subjects ingested a 260-kcal meal, a ROM capsule, and the SmartPill. Subjects wore a data receiver and kept daily stool diaries for 5 days. SmartPill recordings assessed CTT, whole-gut transit time (WGTT), small-bowel transit time, and gastric emptying time. Abdominal radiographs on days 2 and 5 assessed ROM transit. Sensitivity/specificity and receiver operating characteristics (ROCs) of each technique and utility were compared.

Results

Gastric emptying time, CTT, and WGTT were slower (P < .01) in constipated subjects than controls. CTT was slower in women than men (P = .02). Day 2 and day 5 ROM transits were slower (P < .001) in constipated subjects. Correlation of the SmartPill CTT with ROMs expelled on day 2/day 5 was r = 0.74/r = 0.69 in constipation, and r = 0.70/r = 0.40 in controls, respectively. The diagnostic accuracy of the SmartPill CTT to predict constipation from ROC was 0.73, with a specificity of 0.95. These were comparable with those of day 5 ROM (ROC, 0.71; specificity, 0.95).

Conclusions

The SmartPill is a novel ambulatory technique of assessing regional (gastric, small bowel, colonic) and WGTT without radiation. It reveals hitherto unrecognized gender differences and upper-gut dysfunction in constipation. It correlates well with ROM and offers a standardized method of discriminating normal from slow colonic transit.

Abbreviations used in this paper: AUC, area under the curve, CTT, colonic transit time, GET, gastric emptying time, ROC, receiver operating characteristic, ROM, radiopaque marker, SBTT, small-bowel transit time, WGTT, whole-gut transit time

 

 Conflicts of interest Dr Rao, Dr Chey, Dr Hasler, Dr Kuo, Dr Lackner, Dr McCallum, Dr Parkman, Dr Koch, and Dr Sitrin serve as speakers, consultants, or advisory board members for the SmartPill Corporation, and have received research funding from the SmartPill Corporation. Dr DiBaise, Dr Miller, and Dr Saad have received research funding from the SmartPill Corporation. Dr Wilding serves as a consultant to the SmartPill Corporation. Dr Semler is an employee of the SmartPill Corporation and owns stock in the SmartPill Corporation.

 Funding Grant support was received from the SmartPill Corporation, Buffalo, New York.

PII: S1542-3565(09)00061-5

doi:10.1016/j.cgh.2009.01.017

Clinical Gastroenterology and Hepatology
Volume 7, Issue 5 , Pages 537-544, May 2009