Small intestinal transit in patients with liver cirrhosis and portal hypertension: a descriptive study

BACKGROUND Gastrointestinal dysmotility may be involved in the development of bacterial translocation and infection in patients with liver cirrhosis. The aim of the present study was to describe gastric, small intestinal and colorectal motility and transit in patients with liver cirrhosis and portal hypertension using a magnet-based Motility Tracking System (MTS-1) and standard radiopaque markers. METHODS We included 15 patients with liver cirrhosis (8 Child-Pugh A, 6 Child-Pugh B, and 1 Child-Pugh C) and portal hypertension (11 males, median age 54 years (range 38-73), median hepatic venous pressure gradient 18 mmHg (range 12-37)), and 18 healthy controls (8 males, median age 58 years (range 34-64)). The gastric emptying time and small intestinal motility were evaluated by MTS-1, and the total gastrointestinal transit time was assessed by radiopaque markers and abdominal radiographs. RESULTS The velocity through the proximal small intestine was significantly higher in cirrhotic patients (median 1.27 metres (m)/hour, range 0.82-2.68) than in the healthy controls (median 1.00 m/hour, range 0.46-1.88) (p = 0.03). Likewise, the magnet travelled significantly longer in both fast (p = 0.04) and slow movements (p = 0.05) in the patient group. There was no significant difference in either gastric emptying time--23 minutes (range 5-131) in patients and 29 minutes (range 10.5-182) in healthy controls (p = 0.43)--or total gastrointestinal transit time--1.6 days (range 0.5-2.9) in patients and 2.0 days (range 1.0-3.9) in healthy controls (p = 0.33). No correlation was observed between the hepatic venous pressure gradient and the velocity of the magnet through the small intestine. CONCLUSION Patients with liver cirrhosis and portal hypertension demonstrated faster-than-normal transit through the proximal small intestine. This may be due to an overactive bowel, as suggested by previous studies.