SmartPill procedure

I am currently having a SmartPill procedure and wondering where it is inside me. The pH reading on the receiver is less of an indicator since I am on a PPI med so the pH changes will be more subtle (lowest was maybe ~5.5). Still, according to a 2010 study, pressure readings are adequate to establish progression (or lack thereof). I wonder if it will corroborate my gastroparesis Dx, or add more insight.

I am interested in any related experiences/thoughts.

One concern I have is that it is a single lump, and it either leaves your stomach (or other region) or does not. There is no partial representation, but only time as an indicator. It seems that one could have a time of 5 hours once, and if repeated perhaps the 25 hours (without gastroparesis being worse), especially if one has a motility disorder. But overall, I think its benefits should make it worthwhile. The office I am having it at has very limited experience... has been conducting few because of fears of no insurance reimbursement.

Edited March 23, 2012 at 12:22 am

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Hi,
the smartpill is the only study I haven't had. I'm on a wait list for it because they want to put in a feeding tube, but want to check the SI motility first.
It's very interesting that you're still on your PPI. I was told I have to go off mine the week before I start the study and of course all during the study.
I can take Zantac, but have to stop that three days before. They're not going to let me take anything, not even zofran for nausea.
I'm in for a week of hell, that's for sure! :)
Let us know how you do.
Take care,
Jo

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The doc may not be aware you can stay on your PPI. Zantac, however, being an H2 blocker is likely to delay emptying, and I also would have needed to stop that too. They do not need 'regular' stomach pH to determine motility, as the study below about this exact issue with the SmartPill showed. In fact, you are likely to get an inaccurate picture if you worsen when stopping the PPI, and especially if you have been on it for a while like I have.

They suggested I stop the PPI and I said it was a bad idea. They called SmartPill, and they stated it was not necessary to stop with their technology.

_ _ _
"Impact of Acid Suppression on Upper Gastrointestinal pH and Motility" 2010 Whitney Michalek, John R. Semler and Braden Kuo

Results
There was no difference in gastric emptying time, small bowel transit time (SBTT), or pressure profiles between the groups. The pH in all cases rose ≥ 0.5 pH units. Distal small bowel pH was significantly lower in subjects on PPIs. Gastric emptying time was identified in all subjects treated with PPIs. Pressure and slope criteria were developed to confirm the time of emptying.
Conclusion
PPI therapy does not have a significant impact on upper gastrointestinal transit and motility but it does decrease distal small bowel pH. The medication reduced the magnitude of pH change at gastric emptying time but using additional criteria based on slope and contraction frequency, WMC was able to measure gastric emptying time in all patients treated with PPIs.

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I had the smart pill done in January and it was the best thing I have done. I have Gastroparesis from what it said. M y emptying time was 21hrs. 55min. So that means that the meal they gave me stays in my stomach for that long. I t took so long infact that the doc couldnt even test the small bowel.. I met with him a month later and he changed me fro erythromycin, to another type medicine which basically does the same, only in pill form. I have to tell ya. IT does not work at all. and what really sucks is that im supposed to take it 3 days on 4 days off!!! so for the 3 days on, it doesnt work. and on the 4 days off, IT REALLY DOESNT WORK. Im still eating baby food, and either boost or ensure.. I cannot even eat a darn popcicle without getting sick!! And, to top it all off. The last time I met with my Motility doc, he stated that my GP was caused during my Gallbladder surgery which I had performed in July of 2011.... Hmmmmm, like a week after the surgery, which took the gallbladder pain away, I started having these other symptoms going on. And low-and-behold.... I have Gastroparesis!!! And now like I said. I have it confirmed that it wAS due to my GB Surgery.. Anyways the Smart-pill is definately AWESOME!!! I had the Gastric emp study done in Dec and that was not significant. But my doc explained to me as to why the GES is soooo inferioer to the smart-pill.. And it is.... Anyways I wish you MUCH LUCK... Trust me, I know exactly what your going thru.... Let us know how it worked out.. BTW, I was told by my doc that Prilosec, Prevacid, stuff like that can be taken during the smart pill, just not in the 1st 8 hrs.... Good luck, and God bless you and everyone else..

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Is the Smart Pill the same as having a capsule endoscopy? I am scheduled to have one as well as receive Botox next month.

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Thanks for the info!
I'll mention it, but my Dr is one of the leading motility experts in Boston, so he knows what the pill delivers and what he wants for data. let us know the results!

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Thanks! It must be so fustrating to know the surgery caused your gp.
I had gp long before my gallbladder was taken out. I know mine is the result of autonomic failure and not due to human failure.
There are just way too many people here who have gp as a result of surgical error. That's horrible!
My two GES showed severe gp. My insurance in the past wouldn't pay for the smart pill. Now because they're considering a feeding tube and need to check SI motility, maybe they will, maybe they won't!
Take care everyone!
Jo

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SmartPill is not capsule endo. It takes pH, pressure and temperature measurements. No images.

At first my sentiment was,,, why not at least put a basic camera. I think they needed to differentiate their product, and especially the pressure system took up enough space.

Also Smartpill is done 'naturally' with regular food in your system etc. after an initial 6 hour fast, whereas capsule endo involves clearing it and usually goes through you faster, ~12 hours. Not sure about capsule details.

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Hey TBOjo, who is your GI doc in Boston? Just curious because mine is down there..

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I would think SmartPill should be repeated 3 or so times, and averaged for a good picture.

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Just curious, who do you see in Boston? My GP doc is in Boston too. Are we all see the same doc? Maybe we can get together for a pizza feast after our next visit!!! LOL ^_^

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I think I passed my pill in just 31 hours. All readings have stopped changing and there is an "X" looking symbol in lower left of display...

I've been feeling good the last two days too. I hope it keeps up. I hope stopping the prokinetic meds 48 hours in advance was adequate. Eating lightly the two days before, may have helped. The last time I stopped the domperidone I think at like 72 hours symptoms started returning.

Crossing my fingers this is the beginning of a good period.

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Hi M9spencer,
I see Dr Lembo, however I'm going to Dr Kuo for the smartpill.
BIDMC is going to go back to doing smartpill studies because insurance companies are covering it better.
I'm thinking you see Dr Kuo? There is a Dr at B & W that does does smartpill studies too.
I didn't meet with Dr Kuo, just received their basic instructions in the mail, which said to go off all PPI the week before the study. Hopefully, he'll say I can go back on them after 8 hrs. (since he helped develop it, I don't think he's going to let me vary the directions)
My appt isn't booked till the middle of July. If BIDMC gets it back before then, then I'll go there.
All my other testing came back as severe. I've had this for over 6 years. They're only doing this study to scope things out for a possible feeding tube.
How long does it take you to get into Boston? It's 2 hrs for me, not bad. It takes longer in heavy traffic.

Did you eat supper the night before the test? I know if I eat supper it will still be in my stomach the next morning.
I'm thinking it will mess up their data as to exactly how much food is left in the stomach if I eat supper.
Hmmm...........

Take care everyone!!
Jo

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Who do you see sapphire0698?
I have a few years on you. I'll be 50 the end of the year.
The last time I ate pizza, I couldn't eat for a few days afterward, we could try it! :)
do you think there's a mashed potato restaurant, one that doesn't put a ton of cream and butter in them? LOL!
I'm a few hrs west of the big city. I hate driving in Boston!
Take care, Jo

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Lol whats pizza? Hahaha.... My doc for smart pill is dr. mashimo thru the va center in jamauca plains. And yes I could eat the night b4 the test.. Kinda like a fasting lab ( 12 hrs. ) only thing I could take the day of was my omeprazole..

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I never heard of him/her. I'm jealous. the directions say no meds. I'm hoping that BIDMC gets the pill back by then.

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Any directions can be negotiated if there is a mid-way between diagnostic needs and patient needs. If they are causing you more pain than necessary by stopping a med, and it is not essential, talk to them about it. I sometimes needs to make myself take this approach, and honestly it would be easier for me to do if I were representing someone else. But, please, by all means ask for what you think is best med wise.

I am FRUSTRATED. I stopped my domperidone 48 hours before the test as requested. My GP symptoms were almost absent during this period, and returned after dinner tonight. I definitely needed more like 4 days of the prokinetic meds... it feels like a wasted test. I just passed the thing in 31 hours, and I think my GI system was working above baseline. And I HAD to negotiate between insurance and this office to get the test.

BTW, the people at SmartPill corp are a great resource. They have been my go-to as the docs office has only done 3 of these before me... and I think they all were in 2011...

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Hey TBOjo, It takes me (from Maine) about 2 1/2 hrs to get to Boston. Dr. Mashimo (he) works thru the VA and I think Beth Israel?. Or Mass Gen.... Not really sure which it is.. He is def an AWESOME dR. The best 1 I have had yet!! Unfortunately, I dont get to see him again until July GRRRR!!!! Thats wayyyyy to long!!! When I do see him again, I am to have a scope performed, and possibly Botox.... I guess if my stomach opening is closed (which he thinks) then he is going to inject Botox to relax the opening... He said that thru recent studies, that the pacemaker is too risky to perform.. I guess alot of infections happen this way.. I have litteraly spent 8 mnths screwing around with GI Dr's that proclaimed. "You just have IBS!" lOL IBS MY AZZZZZ!!! LOL.. I finally had 1 doc point blank say, that he didnt know what was wrong with me, and he referred me to Boston. (THANK GOD!!!) Iam hoping I can get to see him a lil sooner. The med he put me on DOES NOT WORK! : ( I'm sure your the same... I spend my day either on the couch, or in bed cuz i hurt too bad or am to nauseus to move.. I pretty much eat ensures and boost"s most days. I even get sick on Baby food.... I was 240 lbs when this all started in June of 2011,. I am now down to 180, and can only consume 900-1200 cal a day (IF I DARE.) I have my SSDI paperwork in, and am waiting on that. I'M also waiting on my Lawyer to get ahold of my med records to see if I truely do have a mal-practice case.. We are both pretty sure that we do, but just a formality.. Dr. Mashimo stated that Gastroparesis was due to my Gallbladder surgery when my Vagus nerve was snipped. The surgeon indicated that he had to cut around "alot of adhesions." So basically while he was doing that, he cut my damn vagus!! Lol sorry. I like to ramble sometimes.. anyways, everyone take care of yourselves, and I wish you great health dont ever let GP kick your butt! Dont give in... night all... : )

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I see Dr. Kuo. But their operation has the NPs to do follow-ups for the most part. We don't get to see the doc that often at all. I asked about the smart pill. Dr. Kuo said for my case it would make more sense to do the dual probe and a motility test (whatever that means) because of my other conditions. They sent me the procedure packets and I realized I would be allowed to take my meds after the insert the tube. They will do the motility test first. I was so relieved! I was so worry about stopping my meds for a week or two. My GI track will get all burned up without the meds! That will cause a domino effect of consequences. I guess he did not want my other docs go after him...lol Was that you asked me about Whole Foods couple days ago? I got the mac n cheese right downstairs of his office. They also make very good mashed potatoes! Very greasy though... Why do they want to put a Whole Foods right downstairs of my GP doc??? lol... Torture! Torture!! Torture!!!!

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Pizza is one of those delicious foods that makes GP-ers suffer with joy!!! I know, one large pizza lasted me almost 6 months in the freezer... GP and LPR are so commonly overlooked by docs! I guess many of them are just not listening to what we are trying to describe to them. If they listen carefully, they would know the symptoms that we are talking about. Unfortunately, docs are not required to take a course of counseling theory to learn to listening skills...and talking skills...

Should I be a bad guy to mention a place in JP? There is a place called Center Street Cafe that makes the best nachos that I have had so far! I know I am a horrible person... I really miss that place though...

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Hi Frosch, I’m usually pretty good at negotiating. The problem is that I’m not even seeing the GI doing the test. My hospital doesn’t have the test right now and since I see a motility GI, they just scheduled the test. The Dr in charge of the test is Dr Kuo- he helped develop the smart pill, you see his name on all the papers. I see my GI before I do the test, so I’ll check with him. The pill study isn’t even until the middle of July because they do so much of them.
They wanted to do another GES. I refused that test. They could not modify the food intake and there was no way I could eat that much food. At my center it’s two pieces of toast with jelly, two eggs, and ½ glass of water. I couldn’t eat the whole meal 4 years ago and I’m ever worse now! I’m sorry you’re so frustrated. I’m hoping the test gave them enough information. Thanks for the info. Take care! Jo

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