Chanpong, Atchariya; (2023) The clinical utility of small intestinal function tests in gastrointestinal motility disorders. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Paediatric intestinal pseudo-obstruction (PIPO) is a severe gastrointestinal (GI) motility disorder characterized by symptoms/signs of intestinal obstruction in the absence of luminal occlusion. The diagnosis relies on clinical picture and particularly GI function tests for small intestinal dysmotility including histopathology, antroduodenal manometry (ADM), and small bowel scintigraphy (SBS). The study aims to evaluate the utility of small intestinal function tests for the diagnosis of PIPO in children. / Method: Patients undergoing investigations for suspected foregut dysmotility (including PIPO) from 2012 to 2021 at Great Ormond Street Hospital, UK were retrospectively reviewed and recruited for prospective studies to evaluate the utility and correlation between different modalities for evaluation of small bowel physiology. These included enhanced ADM, enhanced histology, organ bath assay and molecular analysis of full-thickness small intestine, and small bowel transit scintigraphy. In addition, patients undergoing investigations for assessment of GI motility disorders between January and December 2021 at Queensland Children’s Hospital, Australia, were recruited for a specific study on small bowel scintigraphy. Statistical analysis was performed with SPSS and P<0.05 was considered significant. / Results: For ADM and histopathology, 29 PIPO and 11 non-PIPO patients were included. No agreement in diagnosis was found between conventional ADM analysis and histopathology; however, the newly developed enhanced ADM analysis and associated score could discriminate between PIPO and non-PIPO patients, and between distinct histopathological pathologies. Eight PIPO patients and 10 controls were included for enhanced histology, organ bath assay and molecular analysis. The contractility parameters were different between PIPO, and control patients and the tests could classify PIPO samples into two subgroups. For SBS study, 63 patients were included. PIPO patients had a significantly delayed small bowel transit with both liquid and solid tests. / Conclusion: These studies supported the potential utility of enhanced ADM, organ bath assay and SBS as diagnostic tools for PIPO.

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