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Capsules for the Diagnosis and Treatment of Gastrointestinal Motility Disorders- A Game Changer

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Abstract

Purpose of Review

Over the last few decades, there have been remarkable strides in endoscopy and radiological imaging that have advanced gastroenterology. However, the management of neurogastroenterological disorders has lagged behind, in part handicapped by the use of catheter-based manometry that is both non-physiological and uncomfortable. The advent of capsule technology has been a game changer for both diagnostic and therapeutic applications.

Recent Findings

Here, we discuss several capsule devices that are available or under investigation. There are three technologies that are FDA approved. Wireless motility capsule measures pH and pressure and provides clinically impactful information regarding gastric, small intestine and colonic transit, without radiation that has been demonstrated to guide management of gastroparesis, dyspepsia and constipation. Wireless ambulatory pH monitoring capsule is currently the gold standard for assessing gastroesophageal acid reflux. In the therapeutics arena, an orally ingested vibrating capsule has been recently FDA approved for the treatment of chronic constipation, supported by a robust phase 3 clinical trial which showed significant improvement in constipation symptoms and quality of life. There are several capsules currently under investigation. Smart capsule bacterial detection system and Capscan® are capsules that can sample fluid in the small or large bowel and provide microbiome analysis for detection of small intestinal bacterial (SIBO) or fungal overgrowth (SIFO). Another investigational gas sensing capsule analyzing hydrogen, CO2, volatile fatty acids and capsule orientation, can measure regional gut transit time and luminal gas concentrations and assess gastroparesis, constipation or SIBO. Therapeutically, other vibrating capsules are in development.

Summary

Innovations in capsule technology are poised to transform our ability to investigate gut function physiologically, and non-invasively deliver targeted treatment(s), thereby providing both accurate diagnostic information and luminally-directed, safe therapy.

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References

Papers of particular interest, published recently, have been highlighted as: •• of major importance

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Acknowledgements

Dr Rao was supported in part by NIH grant DK115572-02, RO1 DK 121003-05 and grant DK 13148801. We sincerely acknowledge the expert secretarial assistance of Mrs. Helen Smith.

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Authors and Affiliations

  1. Stanford University, Palo Alto, CA, USA

    Irene Sonu

  2. Johns Hopkins University, Baltimore, MD, USA

    Sun Jung Oh

  3. Division of Gastroenterology and Hepatology, Medical College of Georgia, Augusta University, 1120 15th Street, BBR 2538, Augusta, GA, 30912, USA

    Satish S. C. Rao

Authors
  1. Irene Sonu
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Contributions

Irene Sonu – Manuscript concept and design, literature review, manuscript preparation, tables and figures and critical revision.

Sun Jung Oh – Manuscript concept and design, literature review, manuscript preparation, tables and figures and critical revision.

Satish Rao – Manuscript concept and design, data analysis, manuscript preparation, overall supervision and critical revision.

All authors have approved the final version of the manuscript submitted.

Corresponding author

Correspondence to Satish S. C. Rao.

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Conflict of Interest

Dr Rao serves as an advisor and has received research grant support from Medtronic (Smartpill), Vibrant Ltd (Vibrating capsule), Atmo biosciences (Atmo capsule), Biora Therapeutics (SCBDS capsule). Dr Sonu and Dr Oh declare no conflicts of interests with this study.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract

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Sonu, I., Oh, S.J. & Rao, S.S.C. Capsules for the Diagnosis and Treatment of Gastrointestinal Motility Disorders- A Game Changer. Curr Gastroenterol Rep (2024). https://doi.org/10.1007/s11894-024-00926-8

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