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Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Magnetic resonance imaging assessed enteric motility and luminal content analysis in patients with severe bloating
Ruaridh M Gollifer1, Stuart A Taylor1, Alex Menys1
1Centre for Medical Imaging, University College London (UCL), London, UK.
Background:
Gastrointestinal symptoms in functional gut disorders occur without any discernible structural gut abnormality. Preliminary observations on enteric MRI suggest possible abnormal content and motility of the terminal ileum (TI) in constipation-predominant IBS (IBS-C) with severe bloating, and in functional bloating and distension (FABD) patients. We investigated whether MRI can quantify differences in small bowel (SB) content and motility between patients and healthy controls (HCs).
Methods:
11 IBS-C (mean age 40 [21-52] years; 10 women) and 7 FABD (36 [21-56]; all women) patients with bloating and 20 HCs (28 [22-48]; 6 women) underwent enteric MRI, including dynamic motility and anatomical sequences. Three texture analysis (TA) parameters assessed the homogeneity of the luminal content, with ratios calculated between the TI and (1) the SB and (2) the ascending colon. Four TI motility metrics were derived. Ascending colon diameter (ACD) was measured. A comparison between HCs and patients was performed independently for: (1) three TA parameters, (2) four TI motility metrics, and (3) ACD.
Key Results:
Compared with HCs, patients had TI:colon ratios higher for TA contrast (p < 0.001), decreased TI motility (lower mean motility [p = 0.04], spatial motility variation [p = 0.03], and area of motile TI [p = 0.03]), and increased ACD (p = 0.001).
Conclusions And Inferences:
IBS-C and FABD patients show reduced TI motility and differences in luminal content compared with HCs. This potentially indicates reflux of colonic contents or delayed clearance of the TI, which alongside increased ACD may contribute to symptoms of constipation and bloating.
Insights
Patients with functional gut disorders like IBS-C and FABD exhibit reduced terminal ileum motility and altered small bowel content compared to healthy individuals. These MRI findings may explain constipation and bloating symptoms.
Area of Science:
- Gastroenterology
- Medical Imaging
- Functional Gut Disorders
Background:
- Functional gut disorders present with gastrointestinal symptoms without structural abnormalities.
- Enteric MRI preliminary observations suggest abnormal terminal ileum (TI) content and motility in constipation-predominant irritable bowel syndrome (IBS-C) and functional bloating and distension (FABD) patients.
- Investigating MRI's capability to quantify small bowel (SB) content and motility differences between patients and healthy controls (HCs).
Purpose of the Study:
- To investigate if MRI can quantify differences in small bowel (SB) content and motility between patients with functional gut disorders and healthy controls (HCs).
- To assess texture analysis (TA) parameters and motility metrics of the terminal ileum (TI) in patients with IBS-C and FABD compared to HCs.
Main Methods:
- Enteric MRI, including dynamic motility and anatomical sequences, was performed on 11 IBS-C patients, 7 FABD patients, and 20 HCs.
- Texture analysis (TA) parameters assessed luminal content homogeneity, with ratios calculated between the TI and the SB/ascending colon.
- Four TI motility metrics and ascending colon diameter (ACD) were measured and compared between groups.
Main Results:
- Patients exhibited higher TI:colon TA contrast ratios (p < 0.001) compared to HCs.
- Patients showed decreased TI motility, including lower mean motility (p = 0.04), spatial motility variation (p = 0.03), and area of motile TI (p = 0.03).
- Increased ascending colon diameter (ACD) (p = 0.001) was observed in patients compared to HCs.
Conclusions:
- IBS-C and FABD patients demonstrate reduced TI motility and altered luminal content compared to HCs.
- Findings suggest potential reflux of colonic contents or delayed TI clearance in patients.
- These factors, along with increased ACD, may contribute to constipation and bloating symptoms in functional gut disorders.
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