Using the information gained from wireless motility capsule (WMC) testing, diabetic patients suffering from gastrointestinal dysmotility may find avenues towards better clinical management and improved symptoms.
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A study from the Cleveland Clinic presented by Michael Cline, DO, at ACG 2016 explores the benefits of WMC testing towards finding more specialized treatment options for varying patterns of gastroparesis.
“We hope that by publishing this information it will show that the wireless motility capsule is a vital part of the workup. In our research, we found that at least 60 percent of the time the capsule changed, or at least altered the clinical path we were taking on these patients,” Dr. Cline explains.
How it works
WMC testing is a painless procedure used to assess diabetic patients with suspected GI dysmotility. It involves the patient ingesting a capsule and wearing a receiver for three to five days. As the patient goes about his or her daily activities, the capsule gathers information on pressure, pH level and temperature from the intestinal tract. As far as GI procedures go, it is a noninvasive and comprehensive process that can provide the transit profile of the entire GI tract in a single test.
Dr. Cline is hopeful this study will aid gastroenterologists in utilizing WMC testing before considering more complicated procedures. “Before embarking on a certain pathway that may include invasive options such as surgery, including implementation of a gastric stimulator, we hope that a consideration for wireless motility capsule testing be entertained,” he says.
A look at the data
The records of all diabetic patients who underwent WMC testing at Cleveland Clinic between 2010 and 2015 were reviewed. Patients who had undergone gut surgery, or who had a previous history of inflammatory bowel disease or gut cancer were excluded from the study. The results of the WMC testing were then classified as either isolated versus multiregional dysmotility.
There were 47 patients included in the study. The mean age was 46 ± 14 years (77 percent female). The most prevalent presenting symptoms were nausea and/or vomiting (96 percent), abdominal pain (74 percent), constipation (72 percent), bloating (53 percent) and diarrhea (32 percent).
Treatments prescribed included ondansetron/promethazine (N = 27), erythromycin (N = 20), metoclopramide (N = 26), domperidone (N = 14), linaclotide (N = 14), polyethylene glycol (N = 13), lubiprostone (N = 7) and mirtazapine (N = 4).
The study found WMC testing was abnormal in 37 (79 percent) patients. Among those, changes in treatment as a result of WMC testing were made in 25 patients (66 percent). Overall, 27 (57 percent) patients reported improvement in at least one symptom. The extent of involvement on WMC testing was not significantly different, with 52 percent having an isolated dysmotility and 48 percent having multiregional involvement (P = 0.9). Response to treatment was highest for linaclotide (64 percent) and lowest for metoclopramide (19 percent).
In a separate study also presented at ACG 2016, Dr. Cline found no association between HbA1c levels or diabetic microvascular complications and pattern of GI dysmotility in diabetic patients undergoing WMC.
Overall, WMC testing led to changes in management of gastrointestinal dysmotility for 66 percent of diabetic patients. Symptom improvement was observed in 57 percent of patients.
Dr. Cline’s team also noted isolated versus multiregional pattern of underlying GI dysmotility does not seem to impact symptom improvement. Multiple treatment options are available with varying symptom response.