Intestinal motility normally produces the propulsion and digestion of ingested food. Intestinal dysmotility is characterized by abnormalities in the strength and/or coordination of the movements of the intestinal tract. The current gold-standard test for evaluation of intestinal motility is intestinal manometry. However, it is an invasive procedure that can only be performed in specialized reference centers. Moreover, this technique can detect only severe intestinal motility disorders, but it can not detect the subtle abnormalities present in some patients with functional gastrointestinal disorders (FGID).

The development of wireless capsule endoscopy represented a new opportunity for the diagnosis of intestinal diseases.  This technology is based on a miniaturized camera, a lighting system and a wireless transmitter embedded in a container the size of a vitamin capsule (11x7mm). The capsule can be ingested by the patient and, as it travels through the digestive tract propelled by peristaltic movements, it transmits pictures of it to an external recorder. The trip takes about 3 hours, during which the camera sends around 30,000 images of the intestine that can be later inspected by a specialist.

For more than five years, a research group lead by Dr. Petia Ivanova Radeva and Dr. Jordi Vitrià, specialists in Computer Vision and Medical Imaging from the University of Barcelona & Computer Vision Center at UAB, and gastroenterology specialists lead by Dr. Fernando Azpiroz from the Hospital Vall d’Hebron in Barcelona have worked together to develop a system for the diagnosis intestinal motility dysfunction based on the images provided by a wireless endoscopic camera. This system claims in diagnosing functional gastrointestinal disorders (FGID), characterized by chronic digestive symptoms that affect up to 30% of the general population. These patients do not show objective abnormalities with conventional endoscopic or imaging tests. It is accepted that a diversity of pathophysiologic mechanisms cause these disorders, including abnormal intestinal motility.

From the medical point of view, research has focused on the description of motility patterns based on visual analysis of capsule images. From the technological point of view, research has concentrated on two aspects: the development of an automatic recognition system that allows the automatic extraction of the motility features from the images and designing a computer aided decision system to assist the specialist in his diagnosis. The system was first validated with a group of severe dysmotility patients and healthy volunteers from the Hospital Vall d’Hebron, obtaining a higher level of reliability than the current gold-standard methodology (intestinal manometry). Recently, it has also been demonstrated that the analysis of motility based on capsule images can also detect abnormalities in a proportion of FGID patients.  This development could replace intestinal manometry as a non-invasive, amply available, test to diagnosis intestinal dysmotility. Its superior diagnostic capability in FGID could also help to better understand and manage these disorders.

The results of this project are currently being transferred to Given Imaging, a world leading company in the field of gastrointestinal diagnosis, who has been supporting this research for several years.

References:

  1. Malagelada, C., De lorio, F., Seguí, S., Mendez, S., Drozdzal, M., Vitria, J., Radeva, P., Santos, J., Accarino, A., Malagelada, J. R. and Azpiroz, F. (2012), Functional gut disorders or disordered gut function? Small bowel dysmotility evidenced by an original technique. Neurogastroenterology & Motility, 24: 223–e105. doi: 10.1111/j.1365-2982.2011.01823.x
  2. Vilarino, F.; Spyridonos, P.; DeIorio, F.; Vitrià, J.; Azpiroz, F.; Radeva, P.; Intestinal Motility Assessment With Video Capsule Endoscopy: Automatic Annotation of Phasic Intestinal Contractions, Medical Imaging, IEEE Transactions on , vol.29, no.2, pp.246-259, Feb. 2010.

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