(From the September 2013 Issue of Pediatrics Online)
Already used for the diagnosis of digestive problems in adults, wireless motility capsules—tiny data recorders that collect information on how food moves through the gut—may also offer an informative and noninvasive diagnostic option for children with gastrointestinal motility disorders, a new study suggests. The research, led by Carlo Di Lorenzo, MD, Division Chief of Gastroenterology, Hepatology and Nutrition at Nationwide Children’s Hospital, offers promising news for families hoping to avoid the invasive and inconvenient diagnostic procedures often required to conclusively identify gastroparesis, a condition in which there is difficulty moving food out of the stomach and through the intestines.
The study, published in June 2013 in The Journal of Pediatrics, explored the capsules’ comparative diagnostic usefulness in identifying disturbances caused by gastroparesis, which often causes severe nausea, vomiting and weight loss. Antroduodenal manometry (ADM) is currently the standard diagnostic procedure in the pediatric population to diagnose the motility disturbances that cause gastroparesis.
“ADM involves insertion of catheters through the nose into the intestine, usually requires a hospital stay and is often poorly accepted by children. It necessitates sedation and is an unpleasant procedure,” says Dr. Di Lorenzo, director of the Motility Center at Nationwide Children’s and senior author on the paper. “We are focused on trying to find a less invasive way to study and treat GI disturbances in children, and compared to standard diagnostic techniques, the wireless motility capsules were well-tolerated, safe, feasible and provided helpful information.”
For the study, Dr. Di Lorenzo and colleagues at Nationwide Children’s and Massachusetts General Hospital compared the results from various diagnostic methods to study gastrointestinal motility on 22 children age 8 to 17. The motility capsules were more sensitive in detecting gastroparesis than another minimally invasive method, scintigraphic gastric emptying. Furthermore, the capsules surpassed ADM in their ability to detect motor abnormalities.
“It would be premature to say we should use just the motility capsule any time a diagnosis of a motility disorder is needed, but preliminary results do show that it can be effective at diagnosing certain gastrointestinal problems in children,” Dr. Di Lorenzo says.
Currently, wireless motility capsules are not approved by the Food and Drug Administration (FDA) for diagnostic use in children. Although some children are ideal candidates for the clinical use of the capsule, Dr. Di Lorenzo and his staff often struggle with getting health insurance companies to cover the cost of the procedure. In addition, use of the capsule presents challenges in the pediatric population that do not often exist among adults.
“The capsule is like a very large vitamin pill, so its size can make it difficult for young children to swallow it,” says Dr. Di Lorenzo. At its present size, the capsule can only be safely used in school-aged children and adolescents, often after coating it in yogurt or pudding to facilitate its ingestion.
Despite its promise for accurate and noninvasive diagnosis of gastroparesis in children, Dr. Di Lorenzo is unsure when—or even whether—to anticipate FDA pediatric approval of the capsule. “There is a much larger market for capsules in adults. It’s a very new technology for pediatric use, and it’s hard to say whether anyone in the capsule industry will try to pursue its approval for kids under the age of 18.”
According to Dr. Di Lorenzo, who also is a professor of clinical pediatrics at The Ohio State University College of Medicine, use of the wireless motility capsule must still be studied more in-depth compared to other noninvasive methods, such as scintigraphy.
“In our study, the wireless motility capsule gave very helpful information regarding transit and motility, but it’s still a very novel technique, and a specialist should be the one to decide whether a capsule or another test is the appropriate tool to use to diagnose gastrointestinal motility disorders,” says Dr. Di Lorenzo.
He and other gastroenterology specialists also see the potential to investigate the wireless motility capsule’s potential for studying colonic motility—an issue they explored in an August 2013 publication in Current Gastroenterology Reports.
Belkind-Gerson J, Tran K, Di Lorenzo C. Novel Techniques to Study Colonic Motor Function in Children. Current Gastroenterology Reports, 2013 Aug, 15(8):335.
Green AD, Belkind-Gerson J, Surjanhata BC, Mousa H, Kuo B, Di Lorenzo C. Wireless Motility Capsule Test in Children with Upper Gastrointestinal Symptoms. The Journal of Pediatrics, 2013 Jun, 162(6):1181-7.