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#Gastroenterology #Hepatology #Multispeciality
Plethora of evidence suggest that modified small intestinal motility in patients of cirrhosis may play an important role in the development of bacterial translocation (BT) by causing bacterial overgrowth in small intestinal. In addition, BT is involved in the development of various complications such as spontaneous bacterial peritonitis, esophageal variceal hemorrhage, and hepatorenal syndrome. However, few studies conducted earlier with the help of antroduodenal manometry to estimate intestinal motility have shown inconsistencies about the association between dysmotility and the severity of cirrhosis.
The aim of the study is to depict the frequency of small bowel motility abnormalities in cirrhotic patients using a wireless motility capsule (SmartPill); and to appraise the association of intestinal dysmotility with liver disease severity and complications of cirrhosis; and to contrast intestinal transit times and motility indices among patients with cirrhosis and healthy controls.
The current study included a prospective study of 20 patients with cirrhosis (10 compensated, 10 decompensated) from February 2011 to July 2011. All patients underwent and completed SmartPill studies. The authors estimated and analysed intestinal transit times, and compared among compensated versus decompensated cirrhotics versus healthy controls. Evaluation of an association was done between intestinal transit delays/motility indices and disease severity and complications of cirrhosis.
The results showed that decompensated cirrhotics had significantly longer small bowel transit times (SBTT) in contrast to compensated cirrhotics (6.17 vs. 3.56 h). A remarkable association was found between SBTT and cirrhosis severity as calculated by Child-Pugh score. Although no statistical alteration was reported between the groups for gastric or colonic transit times, there was a trend toward prolonged transit throughout the gut in decompensated. Longer SBTT was seen in cirrhotics with spontaneous bacterial peritonitis and ascites in comparison to those without.
Thus, it can be concluded that decompensated cirrhotics have slower intestinal transit times in comparison to compensated cirrhotics and healthy controls. However, further prospective studies are warranted to further depict dysmotility in cirrhotics and its association with complications related to BT. This association could help in the diagnosis of patients who are at increased risk for developing severe complications. In addition, characterisation of dysmotility in cirrhotic patients can also aid in identifying patients who can benefit from prophylactic prokinetic and/or antimicrobial therapy.
Source: Chander Roland B, Garcia-Tsao G, Ciarleglio MM, Deng Y, Sheth A. Decompensated cirrhotics have slower intestinal transit times as compared with compensated cirrhotics and healthy controls. J Clin Gastroenterol. 2013 Nov-Dec;47(10):888-93.