title: A prospective randomized controlled study of erythromycin on gastric and small intestinal distention: implications for MR enterography.
abstract: OBJECTIVE
  To assess if erythromycin increases gastric emptying and hence improves small intestinal distention during MR enterography.
  
  
  METHODS
  Gastric, small intestinal, and large intestinal volumes were assessed with MR after neutral oral contrast (1350ml in 45min) and balanced randomization to erythromycin (200mg i.v., age 31±3y, 13 females), or placebo (37±3y, 13 females) in 40 healthy asymptomatic volunteers. Fat-suppressed T2-weighted MR images of the abdomen were acquired on a 1.5T magnet at standard delay times for enterography. Gastric, small, and large intestinal volumes were measured by specialized software. In addition, two radiologists manually measured diameters and percentage distention of jejunal and ileal loops. Treatment effects were evaluated by an ITT analysis based on ANCOVA models.
  
  
  RESULTS
  All subjects tolerated erythromycin. MRI scans of the stomach and intestine were obtained at 62±2 (mean±SEM) and 74±2min respectively after starting oral contrast. Gastric volumes were lower (P<0.0001) after erythromycin (260±49ml) than placebo (688±63ml) but jejunal, ileal, and colonic volumes were not significantly different. However, maximum (76-100%) jejunal distention was more frequently observed (P=0.03) after erythromycin (8/20 subjects [40%]) than placebo (2/20 subjects [10%]). The diameter of a representative ileal loop was greater (P=0.001) after erythromycin (18.8±4.3mm) than placebo (17.3±2.8mm) infusion.
  
  
  CONCLUSIONS
  After ingestion of oral contrast, erythromycin accelerated gastric emptying but effects on small intestinal dimensions were variable. In balance, erythromycin did not substantially enhance small intestinal distention during enterography using current standard delay times.
authors.affiliation: Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.) Program, Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States. Electronic address: bharucha.adil@mayo.edu.
authors.forename: Adil E
authors.initials: AE
authors.lastname: Bharucha
authors.affiliation: Department of Radiology, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States. Electronic address: fidler.jeff@mayo.edu.
authors.forename: Jeff L
authors.initials: JL
authors.lastname: Fidler
authors.affiliation: Department of Radiology, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States. Electronic address: huprich@mayo.edu.
authors.forename: James E
authors.initials: JE
authors.lastname: Huprich
authors.affiliation: Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.) Program, Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States. Electronic address: ratuapli.shiva@mayo.edu.
authors.forename: Shiva K
authors.initials: SK
authors.lastname: Ratuapli
authors.affiliation: Biomedical Imaging Resource, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States. Electronic address: holmes.david3@mayo.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.affiliation: MR Research Laboratory, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States. Electronic address: riederer@mayo.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Riederer
authors.affiliation: Division of Biomedical Statistics and Informatics, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States. Electronic address: zinsmeis@mayo.edu.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
mesh_terms: D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects*; D004917:Erythromycin / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects*; D064368:Healthy Volunteers; D006801:Humans; D007421:Intestine, Small / Q000187:drug effects* / Q000502:physiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011446:Prospective Studies
chemical_list: D003287:Contrast Media; D004917:Erythromycin
keywords: Distention; Enterography; Erythromycin; MRI; Small intestine