Influence of oral contrast type and volume on patient experience and quality of luminal distension at MR Enterography in Crohn's disease: an observational study of patients recruited to the METRIC trial.

OBJECTIVES: To compare the distention quality and patient experience of oral mannitol and polyethylene glycol (PEG) for MRE. METHODS: This study is a retrospective, observational study of a subset of patients enrolled in a multicentre, prospective trial evaluating the diagnostic accuracy of MRE for small bowel Crohn's. Overall and segmental MRE small bowel distention, from 105 patients (64 F, mean age 37) was scored from 0 = poor to 4 = excellent by two experienced observers (68 [65%] mannitol and 37 [35%] PEG). Additionally, 130 patients (77 F, mean age 34) completed a questionnaire rating tolerability of various symptoms immediately and 2 days after MRE (85 [65%] receiving mannitol 45 [35%] receiving PEG). Distension was compared between agents and between those ingesting ≤ 1 L or > 1 L of mannitol using the test of proportions. Tolerability grades were collapsed into "very tolerable," "moderately tolerable," and "not tolerable." RESULTS: Per patient distension quality was similar between agents ("excellent" or "good" in 54% [37/68] versus 46% [17/37]) with mannitol and PEG respectively. Jejunal distension was significantly better with mannitol compared to PEG (40% [27/68] versus 14% [5/37] rated as excellent or good respectively). There was no significant difference according to the volume of mannitol ingested. Symptom tolerability was comparable between agents, although fullness following MRE was graded as "very tolerable" in 27% (12/45) of patients ingesting PEG, verses 44% (37/84) ingesting mannitol, difference 17% (95% CI 0.6 to 34%). CONCLUSION: Mannitol-based solutions and PEG generally achieve comparable distension quality and side effect profiles, although jejunal distension is better quality with mannitol. Neither distension quality nor side-effect profile is altered by ingestion of more than 1 L of mannitol. KEY POINTS: • Mannitol-based and PEG-based oral preparation agents generally achieve comparable distension quality for MRE with the exception of the jejunum which is better distended with mannitol. • Mannitol-based and PEG-based oral preparation agents used for MRE have similar side effect profiles. • Neither distension quality nor side-effect profile is altered by ingestion of more than 1 L of mannitol.

Studying the Drug Delivery Kinetics of a Nanoporous Matrix Using a MIP-Based Thermal Sensing Platform.

The implementation of Molecularly Imprinted Polymers (MIPs) into sensing systems has been demonstrated abundantly over the past few decades. In this article, a novel application for an MIP-based thermal sensing platform is introduced by using the sensor to characterize the drug release kinetics of a nanoporous silver-organic framework. This Ag nanoporous matrix was loaded with acetylsalicylic acid (aspirin) which was used as a model drug compound in this study. The drug elution properties were studied by placing the nanoporous matrix in phosphate buffered saline solution for two days and measuring the drug concentration at regular time intervals. To this extent, an acrylamide-based MIP was synthesized that was able to detect aspirin in a specific and selective manner. Rebinding of the template to the MIP was analyzed using a thermal sensor platform. The results illustrate that the addition of aspirin into the sensing chamber leads to a concentration-dependent increase in the phase shift of a thermal wave that propagates through the MIP-coated sensor chip. After constructing a dose-response curve, this system was used to study the drug release kinetics of the nanoporous matrix, clearly demonstrating that the metalorganic framework releases the drug steadily over the course of the first hour, after which the concentration reaches a plateau. These findings were further confirmed by UV⁻Visible spectroscopy, illustrating a similar time-dependent release in the same concentration range, which demonstrates that the MIP-based platform can indeed be used as a low-cost straightforward tool to assess the efficacy of drug delivery systems in a lab environment.