Use of the Wireless Motility Capsule in the Diagnosis of Gastric Hypochlorhydria: pHinding Extra Value
- PDF / 963,748 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 44 Downloads / 140 Views
STANFORD MULTIDISCIPLINARY SEMINARS
Use of the Wireless Motility Capsule in the Diagnosis of Gastric Hypochlorhydria: pHinding Extra Value George Triadafilopoulos1 · Charles Lombard2 Accepted: 6 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Case Presentation and Evolution An 81-year-old white man was evaluated in our outpatient clinic due to long-term indigestion, belching, bloating, and constipation. His symptoms, which were present for several years, had been attributed to idiopathic constipation for which he had been treated by dietary and pharmacologic means, most recently with lubiprostone (24 mg orally twice daily) and polyethylene glycol (17 gm orally daily), with partial success. Although he experienced intermittent dysphagia to solids, he did not describe any anorexia or weight loss. He reported fatigue, but he denied any gastrointestinal bleeding. Over the years, he maintained generally good health with a daily exercise program of walking several miles per day. His past medical history was only significant for Gilbert’s syndrome and longstanding hypothyroidism, for which he took daily thyroid supplementation. His past surgical history was significant for a remote cholecystectomy and a transient episode of small bowel obstruction that spontaneously and quickly resolved with nasogastric decompression. Three years prior to this presentation, an upper endoscopy had revealed non-specific esophageal dysmotility and gastritis and gastric (antral) intestinal metaplasia without histologic evidence of Helicobacter pylori. A colonoscopy performed one year later revealed mild sigmoid diverticulosis and hemorrhoids, providing no explanation for his increasingly troublesome constipation. A lactulose breath test was negative for small intestinal bacterial overgrowth. Physical examination was completely normal. Laboratory evaluation * George Triadafilopoulos [email protected] Charles Lombard [email protected] 1
Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
Department of Pathology, El Camino Health, Mountain View, CA, USA
2
revealed hemoglobin 14.2 gm/dl, WBC 8.6, platelets 209, TSH 1.12 (normal 0.45–5.3), total bilirubin 1.8 (direct 0.3). A plain abdominal film showed moderate amount of fecal material in the colon. A CT scan with oral contrast revealed gastric wall thickening (Fig. 1) and variable degrees of small bowel dilation (maximal diameter 3.4 cm) without a transition point, consistent with small intestinal dysmotility. Due to his ongoing symptoms, he underwent an antro-duodenal manometry that revealed intestinal dysmotility with myopathic features (not shown). Enteroscopy showed stasis and duodenal dilation and atony with small intestinal fluid retention despite prior 12-h fasting. A trial of prucalopride 2 mg orally daily was unsuccessful in providing symptom relief. Due to these findings suggestive of slow transit, a wireless motility capsule (WMC) study (Smartpill®) revealed a gastric emptyi
Data Loading...
