Breath Methane Does Not Correlate With Constipation Severity or Bloating in Patients With Constipation.

GOALS: We aimed to study (1) if the breath methane level on glucose breath testing (GBT) was associated with constipation severity and (2) compare methane levels between patients with constipation and diarrhea. BACKGROUND: The breath methane level has been associated with constipation and its severity. However, a few recent studies have questioned these associations. STUDY: Patients presenting consecutively to a tertiary care gastroenterology motility laboratory for GBT were included. GBT was performed using 75-g glucose load following a standard, institutional protocol. Constipation and irritable bowel syndrome (IBS) severity was measured using Patient Assessment of Constipation Symptoms (PAC-SYM) and IBS-symptom severity scale (IBS-SSS). RESULTS: In the cohort of 79 constipated patients, there was no significant correlation between baseline or maximum methane levels with total PAC-SYM score. IBS-SSS or bloating severity also did not correlate with baseline or maximum methane levels. The baseline or maximum methane levels of ≥3 and 5 ppm were equally distributed among those with constipation (n=79) and diarrhea (n=122). Only baseline methane levels of ≥10 and ≥20 ppm significantly correlated with constipation (P<0.001 for both). CONCLUSIONS: We found that constipation and bloating severity did not correlate with methane levels on GBT. In addition, only higher baseline methane levels (≥10 and ≥20 ppm) significantly correlated with constipation as baseline methane levels up to 5 ppm were equally common in patients with diarrhea and constipation. Baseline methane levels had better correlation with constipation compared with maximum levels of methane achieved.

EUS versus magnetic resonance imaging in staging rectal adenocarcinoma: a diagnostic test accuracy meta-analysis.

BACKGROUND AND AIMS: EUS and magnetic resonance imaging (MRI) are both used for locoregional staging of rectal cancer, which determines treatment options. There is a lack of consensus on the best modality for locoregional staging, with studies supporting both EUS and MRI. In this study, we performed the first diagnostic test accuracy meta-analysis to compare the diagnostic accuracy, sensitivity, and specificity of EUS and MRI in the staging of rectal cancer. METHODS: A comprehensive electronic literature search up to June 2018 was performed to identify prospective cohort studies directly comparing the accuracy of EUS with MRI in staging nonmetastatic rectal cancer with surgical pathology as the reference standard. Quality of the included studies was measured by using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. A bivariate hierarchical model was used to perform the meta-analysis of diagnostic test accuracy according to the Cochrane approved methodology. Summary receiver operating characteristics were developed, and the area under the curve was calculated for overall and individual T and N staging, for EUS, MRI, and head-to-head comparison. RESULTS: Six of 2475 studies including 234 patients were eligible. Pooled sensitivity and specificity in T staging were .79 (95% confidence interval [CI], .72-.85) and .89 (95% CI, .84-.93) for EUS and .79 (95% CI, .72-.85) and .85 (95% CI, .79-.90) for MRI, respectively. Pooled sensitivity and specificity in N staging were .81 (95% CI, .71-.89) and .88 (95% CI, .80-.94) for EUS and .83 (95% CI, .73-.90), and .90 (95% CI, .82-.95) for MRI, respectively. In area under the curve head-to-head analysis, EUS was superior to MRI in overall T staging (P < .05). EUS outperformed MRI in overall T, overall N, T1, and T3 staging (P < .01), after excluding studies using an endorectal coil for MRI. MRI was superior to EUS in T2 staging (P = .01) in both analyses. CONCLUSIONS: EUS and MRI both provide reasonable diagnostic accuracy in the staging of nonmetastatic rectal cancer. EUS was superior to MRI in overall T staging and overall T and N staging after adjusting for MRI technology. Practitioners should be aware of advantages and disadvantages of both modalities and choose appropriate methods while considering diagnostic accuracy of each test and institutional practices and limitations.

Idiopathic gastroparesis: case report and literature review of diagnostic and treatment modalities.

Gastroparesis is a disorder characterized by a delay in gastric emptying of a meal in the absence of a mechanical gastric outlet obstruction. The most common etiologies include diabetes, postsurgical and idiopathic. Idiopathic Gastroparesis is at least as common as diabetic Gastroparesis in most case series. Diagnosis of Gastroparesis is based on the presence of symptoms such as nausea, vomiting, postprandial abdominal fullness, and on an objectively determined delay in gastric emptying. The true prevalence of Gastroparesis is unknown. Gastric emptying can be assessed by scintigraphy and stable isotope breath tests. Management of Gastroparesis consists of dietary and lifestyle measures, possible pharmacological interventions (prokinetics, antiemetics, intrapyloric botulinum toxin injection) and/or interventions that focus on adequate nutrient intake either through a nasoduodenal tube, percutaneous gastrostomy, or jejunostomy. New advances in drug therapy and gastric electrical stimulation techniques have been introduced and might provide new hope to patients. Presented here is an interesting case of idiopathic Gastroparesis along with its management and review of the literature.