Effect of colonic distension on small bowel motility measured by jejunal high-resolution manometry

Colonic distension; High-resolution manometry; Small bowel motilityDistensió colònica; Manometria d'alta resolució; Motilitat de l'intestí primDistensión colónica; Manometría de alta resolución; Motilidad del intestino delgadoBackground Abnormal motility patterns in the jejunum can be detected in patients with prominent colonic content, and these abnormalities may be due to either a primary jejunal dysfunction or a reflex distortion. The objective of the present study was to determine the effect of colonic distension on small bowel postprandial motility using high-resolution manometry. Methods Single center, controlled, parallel, randomized, single blind study in healthy subjects testing the effect of colonic filling vs sham infusion on the responses to a meal in 16 healthy subjects. Nutrients were continuously infused in the proximal jejunum (2 Kcal/min) during the 2-h study period to induce a steady-state postprandial motor pattern. Jejunal motility was measured by water-perfused, high-resolution manometry. After 1 h postprandial recording (basal period), gas was infused during 7.5 min via a rectal tube (720 mL or sham infusion), and jejunal motility was recorded for another hour. Key Results Jejunal postprandial motility during the basal period was characterized by two overlapping components: a) continuous segmental activity (non-propagated or shortly propagated) and b) intercurrent propagated fronts (3.8 ± 1.1 fronts of 2-5 clustered contractions/h >10 cm propagation). As compared to sham infusion, colonic gas filling: a) inhibited continuous segmental contractile activity (by 17 ± 4%; p = 0.044 vs control group) and b) stimulated intermittent propagated fronts (up to 9.0 ± 2.2 fronts/h; p = 0.017 vs control group). Conclusions and Inferences Long retrograde reflexes induced by colonic distension distort the balance between segmental and propagated activity, and may affect the normal response of the jejunum to food ingestion. Jejunal manometry in patients may be artifacted by colonic overload

Anatomical Laser Microdissection of the Ileum Reveals mtDNA Depletion Recovery in A Mitochondrial Neuro-Gastrointestinal Encephalomyopathy (MNGIE) Patient Receiving Liver Transplant

Microanatomical dissection; Mitochondrial disorders; MtDNA depletionDisección microanatómica; Trastornos mitocondriales; Agotamiento del ADNmtDissecció microanatòmica; Trastorns mitocondrials; Esgotament de l'ADNmtMitochondrial neuro-gastrointestinal encephalomyopathy (MNGIE) is a rare genetic disorder characterized by thymidine phosphorylase (TP) enzyme defect. The absence of TP activity induces the imbalance of mitochondrial nucleotide pool, leading to impaired mitochondrial DNA (mtDNA) replication and depletion. Since mtDNA is required to ensure oxidative phosphorylation, metabolically active tissues may not achieve sufficient energy production. The only effective life-saving approach in MNGIE has been the permanent replacement of TP via allogeneic hematopoietic stem cell or liver transplantation. However, the follow-up of transplanted patients showed that gut tissue changes do not revert and fatal complications, such as massive gastrointestinal bleeding, can occur. The purpose of this study was to clarify whether the reintroduction of TP after transplant can recover mtDNA copy number in a normal range. Using laser capture microdissection and droplet-digital-PCR, we assessed the mtDNA copy number in each layer of full-thickness ileal samples of a naive MNGIE cohort vs. controls and in a patient pre- and post-TP replacement. The treatment led to a significant recovery of gut tissue mtDNA amount, thus showing its efficacy. Our results indicate that a timely TP replacement is needed to maximize therapeutic success before irreversible degenerative tissue changes occur in MNGIE.The work was supported by Ministero dell’Istruzione, dell’Università e della Ricerca-Dipartimenti eccellenti on the Project Personalized medicine. LC and VC are supported by the Italian Ministry of Health (Ricerca Corrente 2021 funding). RDG is supported by funds from the University of Ferrara

Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction

Constipation; Intestinal manometry; Intestinal neuropathyRestrenyiment; Manometria intestinal; Neuropatia intestinalEstreñimiento; Manometría intestinal; Neuropatía intestinalIntroduction Minute rhythm and prolonged simultaneous contractions are patterns of postprandial small bowel contractile activity that historically have been considered as suggestive of mechanical intestinal obstruction; however, these patterns have been also encountered in patients with motility-like symptoms in the absence of bowel obstruction. The objective of this study was to determine the current diagnostic outcome of patients with these intestinal manometry patterns. Methods Retrospective study of patients with chronic digestive symptoms evaluated by intestinal manometry at our center between 2010 and 2018. Results The minute rhythm (MRP) or prolonged simultaneous contractions (PSC) postprandial patterns were detected in 61 of 488 patients (55 MRP and 6 PSC). Clinical work-up detected a previously non-diagnosed partial mechanical obstruction of the distal intestine in 10 (16%) and a systemic disorder causing intestinal neuropathy in 32 (53%). In the remaining 19 patients (31%, all with MRP), the origin of the contractile pattern was undetermined, but in 16, substantial fecal retention was detected within 7 days of the manometric procedure by abdominal imaging, and in 6 of them colonic cleansing completely normalized intestinal motility on a second manometry performed within 39 ± 30 days. Conclusion and Inference Currently, the most frequent origin of MRP and PSC encountered on small bowel manometry is intestinal neuropathy, while a previously undetected mechanical obstruction is rare. Still, in a substantial proportion of patients, no underlying disease can be identified, and in them, colonic fecal retention might play a role, because in a subgroup of these patients, manometry normalized after colonic cleansing. Hence, colonic preparation may be considered prior to intestinal manometry.This work was supported by the Instituto de Salud Carlos III and co-financed by the European Union (FEDER/FSE) [PI17/01794]; Spanish Ministry of Economy and Competitiveness (Dirección General de Investigación Científica y Técnica) [SAF 2016-76648-R]; Ciberehd is funded by the Instituto de Salud Carlos III. LA was supported by the Instituto de Salud Carlos III (CM20/00182)

Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction

Minute rhythm and prolonged simultaneous contractions are patterns of postprandial small bowel contractile activity that historically have been considered as suggestive of mechanical intestinal obstruction; however, these patterns have been also encountered in patients with motility-like symptoms in the absence of bowel obstruction. The objective of this study was to determine the current diagnostic outcome of patients with these intestinal manometry patterns. Retrospective study of patients with chronic digestive symptoms evaluated by intestinal manometry at our center between 2010 and 2018. The minute rhythm (MRP) or prolonged simultaneous contractions (PSC) postprandial patterns were detected in 61 of 488 patients (55 MRP and 6 PSC). Clinical work-up detected a previously non-diagnosed partial mechanical obstruction of the distal intestine in 10 (16%) and a systemic disorder causing intestinal neuropathy in 32 (53%). In the remaining 19 patients (31%, all with MRP), the origin of the contractile pattern was undetermined, but in 16, substantial fecal retention was detected within 7 days of the manometric procedure by abdominal imaging, and in 6 of them colonic cleansing completely normalized intestinal motility on a second manometry performed within 39 ± 30 days. Currently, the most frequent origin of MRP and PSC encountered on small bowel manometry is intestinal neuropathy, while a previously undetected mechanical obstruction is rare. Still, in a substantial proportion of patients, no underlying disease can be identified, and in them, colonic fecal retention might play a role, because in a subgroup of these patients, manometry normalized after colonic cleansing. Hence, colonic preparation may be considered prior to intestinal manometry. Minute rhythm (or clustered contractions) in postprandial small bowel manometry can be produced by intestinal neuropathy or mechanical occlusion, but in some patients, the minute rhythm pattern is associated with colonic fecal retention, and resolves after colonic cleansing. Hence, colonic preparation may be considered prior to intestinal manometry

End to End Colonic Content Assessment: ColonMetry Application

Colon segmentation; Colonic content; Intestinal gasSegmentación de colon; Contenido colónico; Gas intestinalSegmentació del còlon; Contingut colònic; Gas intestinalThe analysis of colonic contents is a valuable tool for the gastroenterologist and has multiple applications in clinical routine. When considering magnetic resonance imaging (MRI) modalities, T2 weighted images are capable of segmenting the colonic lumen, whereas fecal and gas contents can only be distinguished in T1 weighted images. In this paper, we present an end-to-end quasi-automatic framework that comprises all the steps needed to accurately segment the colon in T2 and T1 images and to extract colonic content and morphology data to provide the quantification of colonic content and morphology data. As a consequence, physicians have gained new insights into the effects of diets and the mechanisms of abdominal distension.This work was supported by the Spanish Ministry of Science and Innovation (Proyectos de Generación de Conocimiento), PID2021-122295OB-I00, and Agencia Estatal de Investigación and Fondos FEDER, PID2021-122136OB-C21); Ciberehd is funded by the Instituto de Salud Carlos III

Artificial intelligence to improve polyp detection and screening time in colon capsule endoscopy

Colon Capsule Endoscopy (CCE) is a minimally invasive procedure which is increasingly being used as an alternative to conventional colonoscopy. Videos recorded by the capsule cameras are long and require one or more experts' time to review and identify polyps or other potential intestinal problems that can lead to major health issues. We developed and tested a multi-platform web application, AI-Tool, which embeds a Convolution Neural Network (CNN) to help CCE reviewers. With the help of artificial intelligence, AI-Tool is able to detect images with high probability of containing a polyp and prioritize them during the reviewing process. With the collaboration of 3 experts that reviewed 18 videos, we compared the classical linear review method using RAPID Reader Software v9.0 and the new software we present. Applying the new strategy, reviewing time was reduced by a factor of 6 and polyp detection sensitivity was increased from 81.08 to 87.80%

Anatomical Laser Microdissection of the Ileum Reveals mtDNA Depletion Recovery in A Mitochondrial Neuro-Gastrointestinal Encephalomyopathy (MNGIE) Patient Receiving Liver Transplant

Mitochondrial neuro-gastrointestinal encephalomyopathy (MNGIE) is a rare genetic disorder characterized by thymidine phosphorylase (TP) enzyme defect. The absence of TP activity induces the imbalance of mitochondrial nucleotide pool, leading to impaired mitochondrial DNA (mtDNA) replication and depletion. Since mtDNA is required to ensure oxidative phosphorylation, metabolically active tissues may not achieve sufficient energy production. The only effective life-saving approach in MNGIE has been the permanent replacement of TP via allogeneic hematopoietic stem cell or liver transplantation. However, the follow-up of transplanted patients showed that gut tissue changes do not revert and fatal complications, such as massive gastrointestinal bleeding, can occur. The purpose of this study was to clarify whether the reintroduction of TP after transplant can recover mtDNA copy number in a normal range. Using laser capture microdissection and droplet-digital-PCR, we assessed the mtDNA copy number in each layer of full-thickness ileal samples of a naive MNGIE cohort vs. controls and in a patient pre- and post-TP replacement. The treatment led to a significant recovery of gut tissue mtDNA amount, thus showing its efficacy. Our results indicate that a timely TP replacement is needed to maximize therapeutic success before irreversible degenerative tissue changes occur in MNGIE

Anatomical Laser Microdissection of the Ileum Reveals mtDNA Depletion Recovery in A Mitochondrial Neuro-Gastrointestinal Encephalomyopathy (MNGIE) Patient Receiving Liver Transplant

mitochondrial neuro-gastrointestinal encephalomyopathy (MNGIE) is a rare genetic disorder characterized by thymidine phosphorylase (TP) enzyme defect. The absence of TP activity induces the imbalance of mitochondrial nucleotide pool, leading to impaired mitochondrial DNA (mtDNA) replication and depletion. Since mtDNA is required to ensure oxidative phosphorylation, metabolically active tissues may not achieve sufficient energy production. The only effective life-saving approach in MNGIE has been the permanent replacement of TP via allogeneic hematopoietic stem cell or liver transplantation. However, the follow-up of transplanted patients showed that gut tissue changes do not revert and fatal complications, such as massive gastrointestinal bleeding, can occur. The purpose of this study was to clarify whether the reintroduction of TP after transplant can recover mtDNA copy number in a normal range. Using laser capture microdissection and droplet-digital-PCR, we assessed the mtDNA copy number in each layer of full-thickness ileal samples of a naive MNGIE cohort vs. controls and in a patient pre- and post-TP replacement. The treatment led to a significant recovery of gut tissue mtDNA amount, thus showing its efficacy. Our results indicate that a timely TP replacement is needed to maximize therapeutic success before irreversible degenerative tissue changes occur in MNGIE

Evaluación de la motilidad intestinal mediante análisis de las imágenes endoluminales

La manometria gastrointestinal es actualmente el método de referencia para el diagnóstico de los trastornos graves de la motilidad intestinal. Este proceso es invasivo, caro y complejo en su interpretación. Nuestro objetivo ha sido analizar las imágenes endoluminales obtenidas por la cápsula endoscópica para la valoración de la motilidad intestinal.El análisis de las imágenes endoluminales se ha realizado mediante un complejo programa informático desarrollado con técnicas de visión por computadora y aprendizaje automático específicamente para estudiar la motilidad del intestino delgado. Permite detectar contracciones intestinales y caracterizarlas según la intensidad de los pliegues concéntricos que se forman en su centro. Se identifican secuencias estáticas en las que el intestino o su contenido presentan muy escaso movimiento. Se detectan secuencias en las que el lúmen intestinal permanece abierto con una imagen tipo "túnel". Se cuantifican las secreciones intestinales turbias y se analiza su movimiento. En un primer estudio de validación, se ha demostrado que los períodos de inhibición de la motilidad intestinal, producidos farmacológicamente, se pueden diferenciar de forma automática de los períodos de actividad fisiológica. Mediante esta técnica se ha demostrado también que la dinámica del contenido intraluminal y la propulsión a lo largo del intestino están relacionadas con la contractilidad muscular y el movimiento de la pared intestinal.En un segundo estudio se ha desarrollado un clasificador informático para detectar motilidad intestinal patológica a partir de las características de la imagen endoluminal. Se estudiaron 36 pacientes con diagnóstico clínico de trastorno grave de la motilidad intestinal (19 con diagnóstico manométrico y 17 sin criterios manométricos) y 50 individuos sanos. A partir de las imágenes endoluminales de estos casos se seleccionaron 19 parámetros para crear un clasificador automático que identificara los casos de motilidad patológica. Los resultados obtenidos fueron los siguientes. El programa informático es capaz de identificar correctamente el 95% de los pacientes con criterios manométricos de trastorno severo de la motilidad intestinal. Asimismo, identifica como anormales el 65% de los pacientes que no cumplían criterios manométricos. Ningún voluntario sano es clasificado como patológico.Se concluye que el análisis de las imágenes endoluminales obtenidas mediante cápsula endoscópica detecta correctamente y de forma no invasiva los trastornos graves de la motilidad gastrointestinal.Gastrointestinal manometry is currently the gold standard diagnostic test for small bowel motility disorders. It is an invasive and expensive procedure that requires expertise for its interpretation. Our aim was to use non-invasive capsule technology for evaluation of intestinal motor function based on computer image analysis.An endoluminal image analysis program for evaluation of intestinal motility was developed using computer vision and machine learning techniques. Intestinal contractions are detected and characterized depending on the intensity of concentric wrinkles that form in the center. Static sequences where the gut or its contents show reduced movement are identified. Sequences where the lumen is open in a tunnel fashion are detected. Intestinal content and endoluminal motion is quantified.An initial validation study showed that periods of pharmacologically inhibited intestinal motility can be automatically distinguished from periods of physiological activity. It also showed that the dynamics of the intraluminal content and propulsion along the intestine are related to the movement of the intestinal wall.In a second study, a computerized classifier was developed to detect small bowel dysmotility based on endoluminal image analysis. 36 patients with a clinical diagnosis of intestinal dysmotility (19 fulfilling manometric criteria and 17 not) and 50 healthy subjects were studied. Based on the endoluminal images from these cases, 19 parameters were selected to develop an automatic classifier for identification of abnormal motility. The classifier correctly identified 95% of patients with manometric criteria of intestinal dysmotility. It also identified as abnormal 65% of the patients who did not meet manometric criteria of dysmotility. All healthy subjects were classified as normal. In conclusion, analysis of endoluminal images obtained by capsule endoscopy constitutes a reliable, non-invasive and automated diagnostic test of intestinal motor disorders

Evaluación de la motilidad intestinal mediante análisis de las imágenes endoluminales

Descripció del recurs: 12 gener 2011La manometria gastrointestinal es actualmente el método de referencia para el diagnóstico de los trastornos graves de la motilidad intestinal. Este proceso es invasivo, caro y complejo en su interpretación. Nuestro objetivo ha sido analizar las imágenes endoluminales obtenidas por la cápsula endoscópica para la valoración de la motilidad intestinal. El análisis de las imágenes endoluminales se ha realizado mediante un complejo programa informático desarrollado con técnicas de visión por computadora y aprendizaje automático específicamente para estudiar la motilidad del intestino delgado. Permite detectar contracciones intestinales y caracterizarlas según la intensidad de los pliegues concéntricos que se forman en su centro. Se identifican secuencias estáticas en las que el intestino o su contenido presentan muy escaso movimiento. Se detectan secuencias en las que el lúmen intestinal permanece abierto con una imagen tipo "túnel". Se cuantifican las secreciones intestinales turbias y se analiza su movimiento. En un primer estudio de validación, se ha demostrado que los períodos de inhibición de la motilidad intestinal, producidos farmacológicamente, se pueden diferenciar de forma automática de los períodos de actividad fisiológica. Mediante esta técnica se ha demostrado también que la dinámica del contenido intraluminal y la propulsión a lo largo del intestino están relacionadas con la contractilidad muscular y el movimiento de la pared intestinal. En un segundo estudio se ha desarrollado un clasificador informático para detectar motilidad intestinal patológica a partir de las características de la imagen endoluminal. Se estudiaron 36 pacientes con diagnóstico clínico de trastorno grave de la motilidad intestinal (19 con diagnóstico manométrico y 17 sin criterios manométricos) y 50 individuos sanos. A partir de las imágenes endoluminales de estos casos se seleccionaron 19 parámetros para crear un clasificador automático que identificara los casos de motilidad patológica. Los resultados obtenidos fueron los siguientes. El programa informático es capaz de identificar correctamente el 95% de los pacientes con criterios manométricos de trastorno severo de la motilidad intestinal. Asimismo, identifica como anormales el 65% de los pacientes que no cumplían criterios manométricos. Ningún voluntario sano es clasificado como patológico. Se concluye que el análisis de las imágenes endoluminales obtenidas mediante cápsula endoscópica detecta correctamente y de forma no invasiva los trastornos graves de la motilidad gastrointestinal.Gastrointestinal manometry is currently the gold standard diagnostic test for small bowel motility disorders. It is an invasive and expensive procedure that requires expertise for its interpretation. Our aim was to use non-invasive capsule technology for evaluation of intestinal motor function based on computer image analysis. An endoluminal image analysis program for evaluation of intestinal motility was developed using computer vision and machine learning techniques. Intestinal contractions are detected and characterized depending on the intensity of concentric wrinkles that form in the center. Static sequences where the gut or its contents show reduced movement are identified. Sequences where the lumen is open in a tunnel fashion are detected. Intestinal content and endoluminal motion is quantified. An initial validation study showed that periods of pharmacologically inhibited intestinal motility can be automatically distinguished from periods of physiological activity. It also showed that the dynamics of the intraluminal content and propulsion along the intestine are related to the movement of the intestinal wall. In a second study, a computerized classifier was developed to detect small bowel dysmotility based on endoluminal image analysis. 36 patients with a clinical diagnosis of intestinal dysmotility (19 fulfilling manometric criteria and 17 not) and 50 healthy subjects were studied. Based on the endoluminal images from these cases, 19 parameters were selected to develop an automatic classifier for identification of abnormal motility. The classifier correctly identified 95% of patients with manometric criteria of intestinal dysmotility. It also identified as abnormal 65% of the patients who did not meet manometric criteria of dysmotility. All healthy subjects were classified as normal. In conclusion, analysis of endoluminal images obtained by capsule endoscopy constitutes a reliable, non-invasive and automated diagnostic test of intestinal motor disorders