PTU-127 The Macrogol MRI Challenge Test: A Novel Non Invasive Colonic Function Test
PTU-127 The Macrogol MRI Challenge Test: A Novel Non Invasive Colonic Function Test
复制标题
PTU-127 聚乙二醇 MRI 挑战测试：一种新型非侵入性结肠功能测试
作者：
C. Lam;G. Chaddock;C. Hoad;C. Costigan;E. Cox;S. Pritchard;L. Marciani;P. Gowland;R. Spiller
简介治疗难治性便秘通常涉及多次侵入性测试，通常令人不快。我们的目标是开发一种更可接受的非侵入性结肠功能测试。方法慢性便秘13例，年龄21~60岁，女：男12：1，慢传输型便秘9例，梗阻性便秘2例，肠易激综合征合并便秘2例。在研究日前24小时进行空腹腹部MRI扫描，通过摄取5粒装满Gd-DOTA溶液的药丸来评估全肠道传输(WGT)。根据先前显示与标准放射不透明标记法有很好相关性的平均加权转运评分(TS)来评估药丸的转运。这使得TS可以转换为以小时为单位的WGT时间。然后，患者服用1升麦角精(MCG)，然后每小时进行一次MRI扫描，时间为4小时，同时他们的肠道症状评分从0到10(非严重)。使用动力指数(以秒/2分钟为单位的收缩持续时间的积分乘以升结肠显示收缩的节数)来评估结肠运动。结果与之前报道的11名健康志愿者(HV)的值进行了比较(2)。结果(平均±扫描电子显微镜)从TS计算的WGT时间CC组为83±12小时，HV组为30±4小时(P<；0.01)。CC组的平均空腹小肠水含量(SBWC)为200±18，高于HV组的51±7ml(p<；0.01)。CC组空腹AC容量为307±26，高于HV组的205±14ml(p<；0.01)。MCG到达升结肠的平均时间CC组为74±7分钟，HV组为65±5分钟(P=0.39)。CC组摄入MCG后2小时的运动指数明显低于HV组，分别为14±14和82±14(P=0.04)。CC组术后2小时结肠扩张较大，AC容量为615±59 ml，HV组为357±46 ml(p<；0.01)。服药后首次排便时间CC组为414±144分钟，HV组为117±21分钟(P=0.04)。摄入MCG当天CC患者的大便频率较HV患者减少，分别为4.5±1.4和8.9±1.2(p<；0.01)。CC组服药后腹胀评分为2.3±0.3，HV组为0.9±0.3(p=0.02)。结论与HV相比，CC患者的空腹SBWC和AC容量增加。当接受MCG挑战时，他们表现出更大的膨胀感和更多的不适，运动能力降低和肠道运动反应延迟。这项核磁共振监测的MCG挑战测试提供了运输、感觉和运动功能的数据。披露利益没有任何声明涉及Lam等人。BSG 2013年提交。Garsed等人。胃肠病学2012；142：S814S。
Introduction Managing resistant constipation commonly involves multiple often unpleasant invasive tests. Our aim was to develop a more acceptable non-invasive colonic function test. Methods 13 patients (ages 21–60, female: male = 12:1) with chronic constipation (CC) unresponsive to simple laxatives; 9 with slow transit constipation, 2 obstructive defecation and 2 IBS with constipation. Whole gut transit (WGT) was assessed by ingesting 5 pills filled with Gadolinium-DOTA solution, 24 hours before study day when a fasting MRI scan of the abdomen was performed. Transit of the pills was assessed from an average weighted Transit Score (TS) previously shown to correlate well with the standard radio-opaque marker method (1). This enabled TS to be converted to WGT time in hours. Patients then ingested 1 litre of macrogol (MCG), followed by hourly MRI scans for 4 hours while they scored bowel symptoms from 0–10 (none – severe). Colonic movements were assessed using a motility index (integral of the duration of contraction in secs/2 minute X multiplied by the number of sections of the ascending colon showing contraction). Results were compared with values from 11 healthy volunteers (HV) previously reported (2). Results (Mean±SEM) WGT time was calculated from the TS to be significantly greater for CC being 83 ± 12 hr vs. 30 ± 4 hr for HV (p < 0.01). The average fasting small bowel water content (SBWC) was increased for CC being 200 ± 18 compared to 51 ± 7ml in HV (p < 0.01). Fasting AC volumes were also greater in CC being 307 ± 26 compared to 205 ± 14ml in HV (p < 0.01). The average arrival time of MCG to the ascending colon (AC) was 74 ± 7 min in CC and 65 ± 5 in HV (p = 0.39). Motility index 2 hours after MCG ingestion was reduced in CC compared to HV being 14 ± 14 and 82 ± 14 (p = 0.04). Distension of the colon at 2 hours by MCG was greater for CC with AC volume of 615 ± 59 vs. 357 ± 46 ml in HV (p < 0.01). Time to first bowel movement after ingestion of MCG was delayed for CC compared to HV at 414 ± 144 and 117 ± 21 min (p = 0.04). Stool frequency for CC on the day of MCG ingestion were reduced compared to HV being 4.5 ± 1.4 versus 8.9 ± 1.2 (p < 0.01). Bloating score following ingestion of MCG was greater in CC being 2.3 ± 0.3 compared to HV 0.9 ± 0.3 (p = 0.02). Conclusion CC patients have increased fasting SBWC and AC volumes compared to HV. When challenged with MCG, they showed greater distension and more discomfort with reduced motility and delayed bowel movement response. This MRI monitored MCG challenge test gives data on transit, sensory and motor function. Disclosure of Interest None Declared References Lam et al. BSG 2013 submission. Garsed et al. Gastroenterology 2012; 142:S814S.