Investigation of colonic and whole-gut transit with wireless motility capsule and radiopaque markers in constipation.
OBJECTIVE
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.
Department of Medicine, University of Iowa, Iowa City, Iowa 52242-1009, USA. satish-rao@uiowa.edu
Satish S C
SS
Rao
Braden
B
Kuo
Richard W
RW
McCallum
William D
WD
Chey
John K
JK
DiBaise
William L
WL
Hasler
Kenneth L
KL
Koch
Jeffrey M
JM
Lackner
Carrie
C
Miller
Richard
R
Saad
Jack R
JR
Semler
Michael D
MD
Sitrin
Gregory E
GE
Wilding
Henry P
HP
Parkman
D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000379:methods*; D003248:Constipation / Q000175:diagnosis*; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D055815:Young Adult