title: Comparative quantitative assessment of global small bowel motility using magnetic resonance imaging in chronic intestinal pseudo-obstruction and healthy controls.
abstract: BACKGROUND
  Chronic intestinal pseudo-obstruction (CIPO) is characterized by dilatation of the bowel lumen and abnormal motility. In this study, we aimed to quantify small bowel dysmotility in CIPO using a validated pan-intestinal motility assessment technique based on motion capture magnetic resonance imaging (MRI) compared to normal controls. In addition, we explored if motility responses of CIPO patients to neostigmine challenge differed from healthy volunteers.
  
  
  METHODS
  Twenty healthy volunteers (mean age 28, range 22-48) and 11 CIPO patients (mean age 47, range 19-90) underwent MRI enterography to capture global small bowel motility. Eleven controls and seven CIPO patients further underwent a randomized placebo-controlled crossover study of either intravenous neostigmine (0.5 mg) or saline with motility MRI repeated at a mean of 3 weeks. Motility was quantified in regions of interest placed to encompass the whole small bowel volume using a validated, postprocessing technique to give a global motility index in arbitrary units (AU). Baseline and stimulated motility was compared using Wilcoxon rank-sum paired T-tests.
  
  
  RESULTS
  Baseline global small bowel motility was significantly lower in CIPO patients compared to controls (mean 0.25 AU vs 0.35 AU, p < 0.001). Motility in both groups increased significantly after neostigmine (0.06 AU increase, p = 0.016 in CIPO and 0.06 AU increase, p = 0.002 in controls). Three patients with scleroderma had a reduced response to neostigmine.
  
  
  CONCLUSIONS
  Global small bowel motility in CIPO patients is significantly lower than controls and response to the pro-kinetic agent neostigmine may differ according to disease phenotype. Software-quantified bowel motility using cine MRI has potential as a future tool to investigate enteric dysmotility.
authors.affiliation: Centre for Medical Imaging, UCL, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Menys
authors.affiliation: Gastroenterology, University College London Hospitals, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Butt
authors.affiliation: Gastroenterology, University College London Hospitals, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Emmanuel
authors.affiliation: Centre for Medical Imaging, UCL, London, UK.
authors.forename: A A
authors.initials: AA
authors.lastname: Plumb
authors.affiliation: Wingate Institute of Neurogastroenterology, Centre for Digestive Diseases, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Fikree
authors.affiliation: Wingate Institute of Neurogastroenterology, Centre for Digestive Diseases, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Knowles
authors.affiliation: Centre for Medical Imaging, UCL, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Atkinson
authors.affiliation: Gastroenterology, University College London Hospitals, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Zarate
authors.affiliation: Centre for Medical Imaging, UCL, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Halligan
authors.affiliation: Centre for Medical Imaging, UCL, London, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D002908:Chronic Disease; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007418:Intestinal Pseudo-Obstruction / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D002800:Cholinesterase Inhibitors; D009388:Neostigmine
keywords: MRI; motility; small bowel