TY - JOUR
T1 - Fasted and fed small bowel motility patterns at cine-MRI in chronic intestinal pseudo-obstruction
AU - van Rijn, Kyra L.
AU - Bredenoord, Albert J.
AU - Smout, André J.P.M.
AU - Bouma, Gerd
AU - Tielbeek, Jeroen A.W.
AU - Horsthuis, Karin
AU - Stoker, Jaap
AU - de Jonge, Catharina S.
N1 - Funding Information: This research was partly funded by the Amsterdam Gastroenterology, Endocrinology and Metabolism institute of Amsterdam UMC. The sponsors had no role in the study design, collection, analysis and interpretation of the data, and writing of the report. Funding Information: This work was presented at NeuroGASTRO 2019 and Digestive Disease Week 2020. KLR, AJPMS, GB, JAWT, KH, and CSJ have nothing to declare. JS has a research agreement with Takeda. AJB received research funding from Nutricia, Norgine, and Bayer and received speaker and/or consulting fees from Laborie, Arena, EsoCap, Diversatek, Medtronic, Dr. Falk Pharma, Calypso Biotech, Thelial, Robarts, Reckitt Benckiser, Regeneron, Celgene, Bayer, Norgine, AstraZeneca, Almirall, Arena, and Allergan and holds stocks in Side Sleep Technologies. 22,23 Publisher Copyright: © The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd
PY - 2021/6
Y1 - 2021/6
N2 - Background: Chronic intestinal pseudo-obstruction (CIPO) is a severe intestinal motility disorder of which the pathophysiology is largely unknown. This study aimed at gaining insight in fasted and fed small bowel motility in CIPO patients using cine-MRI with caloric stimulation. Methods: Eight adult patients with manometrically confirmed CIPO were prospectively included. Patients underwent a cine-MRI protocol after an overnight fast, comprising fasting-state scans and scans after ingestion of a meal (Nutridrink, 300 kcal). Small bowel motility was quantified resulting in a motility score in arbitrary units (AU) and visually assessed by three radiologists. Findings were compared with those in 16 healthy volunteers. Key Results: Motility scores (median, IQR) in CIPO patients were 0.21 (0.15–0.30) in the fasting state and 0.23 (0.15–0.27) directly postprandially. In healthy volunteers, corresponding motility scores were 0.15 (0.13–0.18) and 0.22 (0.19–0.25), respectively. The postprandial change in motility score was +1% (−19 to +21%) in CIPO and +39% (+23 to +50%) in healthy volunteers (p = 0.001*). Visual analysis revealed increased small bowel contractility in four, normal in two, and decreased in two CIPO patients. Conclusions & Inferences: Surprisingly, we found hyperactive small bowel motility in half of the CIPO patients, suggestive of uncoordinated motility. A wide variation in motility patterns was observed, both higher, lower, and comparable contractility compared with healthy subjects. No clear postprandial activation was seen in patients. Cine-MRI helps to gain insight in this complex disease and can potentially impact treatment decisions in the future.
AB - Background: Chronic intestinal pseudo-obstruction (CIPO) is a severe intestinal motility disorder of which the pathophysiology is largely unknown. This study aimed at gaining insight in fasted and fed small bowel motility in CIPO patients using cine-MRI with caloric stimulation. Methods: Eight adult patients with manometrically confirmed CIPO were prospectively included. Patients underwent a cine-MRI protocol after an overnight fast, comprising fasting-state scans and scans after ingestion of a meal (Nutridrink, 300 kcal). Small bowel motility was quantified resulting in a motility score in arbitrary units (AU) and visually assessed by three radiologists. Findings were compared with those in 16 healthy volunteers. Key Results: Motility scores (median, IQR) in CIPO patients were 0.21 (0.15–0.30) in the fasting state and 0.23 (0.15–0.27) directly postprandially. In healthy volunteers, corresponding motility scores were 0.15 (0.13–0.18) and 0.22 (0.19–0.25), respectively. The postprandial change in motility score was +1% (−19 to +21%) in CIPO and +39% (+23 to +50%) in healthy volunteers (p = 0.001*). Visual analysis revealed increased small bowel contractility in four, normal in two, and decreased in two CIPO patients. Conclusions & Inferences: Surprisingly, we found hyperactive small bowel motility in half of the CIPO patients, suggestive of uncoordinated motility. A wide variation in motility patterns was observed, both higher, lower, and comparable contractility compared with healthy subjects. No clear postprandial activation was seen in patients. Cine-MRI helps to gain insight in this complex disease and can potentially impact treatment decisions in the future.
KW - cine magnetic resonance imaging
KW - food challenge
KW - gastrointestinal motility
KW - intestinal pseudo-obstruction
KW - magnetic resonance imaging
KW - small intestine
UR - http://www.scopus.com/inward/record.url?scp=85098077274&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/nmo.14062
DO - https://doi.org/10.1111/nmo.14062
M3 - Article
C2 - 33369013
SN - 1350-1925
VL - 33
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
IS - 6
M1 - e14062
ER -