Rao Satish S C, Kuo Braden, McCallum Richard W, Chey William D, DiBaise John K, Hasler William L, Koch Kenneth L, Lackner Jeffrey M, Miller Carrie, Saad Richard, Semler Jack R, Sitrin Michael D, Wilding Gregory E, Parkman Henry P
Department of Medicine, University of Iowa, Iowa City, Iowa 52242-1009, USA.
Clin Gastroenterol Hepatol. 2009 May;7(5):537-44. doi: 10.1016/j.cgh.2009.01.017.
BACKGROUND & AIMS: Colonic transit time (CTT) traditionally is assessed with radiopaque markers (ROMs), which requires radiation and is hindered by lack of standardization and compliance. We assessed regional and CTT with the SmartPill (SmartPill Corporation, Buffalo, NY), a new wireless pH and pressure recording capsule, in constipated and healthy subjects and compared this with ROM.
Seventy-eight constipated (Rome II) and 87 healthy subjects ingested a 260-kcal meal, a ROM capsule, and the SmartPill. Subjects wore a data receiver and kept daily stool diaries for 5 days. SmartPill recordings assessed CTT, whole-gut transit time (WGTT), small-bowel transit time, and gastric emptying time. Abdominal radiographs on days 2 and 5 assessed ROM transit. Sensitivity/specificity and receiver operating characteristics (ROCs) of each technique and utility were compared.
Gastric emptying time, CTT, and WGTT were slower (P < .01) in constipated subjects than controls. CTT was slower in women than men (P = .02). Day 2 and day 5 ROM transits were slower (P < .001) in constipated subjects. Correlation of the SmartPill CTT with ROMs expelled on day 2/day 5 was r = 0.74/r = 0.69 in constipation, and r = 0.70/r = 0.40 in controls, respectively. The diagnostic accuracy of the SmartPill CTT to predict constipation from ROC was 0.73, with a specificity of 0.95. These were comparable with those of day 5 ROM (ROC, 0.71; specificity, 0.95).
The SmartPill is a novel ambulatory technique of assessing regional (gastric, small bowel, colonic) and WGTT without radiation. It reveals hitherto unrecognized gender differences and upper-gut dysfunction in constipation. It correlates well with ROM and offers a standardized method of discriminating normal from slow colonic transit.
传统上结肠运输时间（CTT）是通过不透X线标志物（ROMs）来评估的，这需要进行辐射，且因缺乏标准化和依从性而受到阻碍。我们使用一种新型的无线pH值和压力记录胶囊SmartPill（SmartPill公司，纽约州布法罗市）对便秘患者和健康受试者的区域运输时间和CTT进行了评估，并将其与ROM评估结果进行了比较。
78名便秘患者（罗马II标准）和87名健康受试者摄入了一顿260千卡的餐食、一粒ROM胶囊和SmartPill。受试者佩戴数据接收器，并连续5天记录每日排便情况。SmartPill记录用于评估CTT、全肠道运输时间（WGTT）、小肠运输时间和胃排空时间。在第2天和第5天拍摄腹部X光片以评估ROM的运输情况。比较了每种技术和工具的敏感性/特异性以及受试者操作特征（ROC）。
便秘患者的胃排空时间、CTT和WGTT比对照组慢（P <.01）。女性的CTT比男性慢（P =.02）。便秘患者在第2天和第5天的ROM运输较慢（P <.001）。在便秘患者中，SmartPill CTT与第2天/第5天排出的ROMs的相关性分别为r = 0.74/r = 0.69，在对照组中分别为r = 0.70/r = 0.40。SmartPill CTT通过ROC预测便秘的诊断准确性为0.73，特异性为0.95。这些结果与第5天ROM的结果相当（ROC，0.71；特异性，0.95）。
SmartPill是一种新型的动态评估区域（胃、小肠、结肠）和WGTT的技术，无需辐射。它揭示了便秘患者中迄今未被认识到的性别差异和上消化道功能障碍。它与ROM相关性良好，并提供了一种区分正常结肠运输和缓慢结肠运输的标准化方法。
