A prospective randomized controlled study of erythromycin on gastric and small intestinal distention: Implications for MR enterography |
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Authors: | Adil E. Bharucha Jeff L. Fidler James E. Huprich Shiva K. Ratuapli David R. Holmes Stephen J. Riederer Alan R. Zinsmeister |
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Affiliation: | 1. Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.) Program, Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States;2. Biomedical Imaging Resource, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States;3. Department of Radiology, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States;4. MR Research Laboratory, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States;5. Division of Biomedical Statistics and Informatics, College of Medicine, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, United States |
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Abstract: | ObjectivesTo assess if erythromycin increases gastric emptying and hence improves small intestinal distention during MR enterography.MethodsGastric, small intestinal, and large intestinal volumes were assessed with MR after neutral oral contrast (1350 ml in 45 min) and balanced randomization to erythromycin (200 mg i.v., age 31 ± 3y, 13 females), or placebo (37 ± 3y, 13 females) in 40 healthy asymptomatic volunteers. Fat-suppressed T2-weighted MR images of the abdomen were acquired on a 1.5 T magnet at standard delay times for enterography. Gastric, small, and large intestinal volumes were measured by specialized software. In addition, two radiologists manually measured diameters and percentage distention of jejunal and ileal loops. Treatment effects were evaluated by an ITT analysis based on ANCOVA models.ResultsAll subjects tolerated erythromycin. MRI scans of the stomach and intestine were obtained at 62 ± 2 (mean ± SEM) and 74 ± 2 min respectively after starting oral contrast. Gastric volumes were lower (P < 0.0001) after erythromycin (260 ± 49 ml) than placebo (688 ± 63 ml) but jejunal, ileal, and colonic volumes were not significantly different. However, maximum (76–100%) jejunal distention was more frequently observed (P = 0.03) after erythromycin (8/20 subjects [40%]) than placebo (2/20 subjects [10%]). The diameter of a representative ileal loop was greater (P = 0.001) after erythromycin (18.8 ± 4.3 mm) than placebo (17.3 ± 2.8 mm) infusion.ConclusionsAfter ingestion of oral contrast, erythromycin accelerated gastric emptying but effects on small intestinal dimensions were variable. In balance, erythromycin did not substantially enhance small intestinal distention during enterography using current standard delay times. |
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Keywords: | Distention Enterography Erythromycin MRI Small intestine |
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