Courtesy SmartPill
Hope Barnes was sick, but even $10,000 in medical tests found no answers.
“I was in so much pain; I didn’t want to be here,” says the 33-year-old mother of two from Mount Joy, Lancaster County.
She had lost 30 pounds in six months. On most days of the week, she says, she would be sick with nausea, bloating, constipation, diarrhea, or in terrible pain. On the other days, she was lucky if she could tolerate any food.
Yet, after four MRIs, a colonoscopy and an upper endoscopy, where a flexible tube was inserted down her throat so a physician could look at her esophagus, stomach and first portion of the small intestine, she was told the tests found nothing wrong.
Then she found Dr. Justin Harberson of Lancaster Gastroenterology (www.lancastergi.com) and the SmartPill.
And that was the start of Barnes getting her life back.
“The pill was a blessing because it is the only reason they found out what is wrong with me,” says Barnes.
Barnes has gastroparesis. It is an illness in which the stomach empties too slowly, which is called delayed emptying.
Gastroparesis and constipation are the two diseases that the SmartPill is used to help diagnose, says Dr. Guoxiang “George” Shi of Gastroenterology Associates of York (www.gastroyork.com) and York Endoscopy Center.
The SmartPill has been used for about three years in the United States, says Shi, and is used in more than 150 sites in the country. Gastroenterology Associates of York began using the new technology in February. Shi says the SmartPill will be more comfortable and more convenient for patients than existing tests. There is no radiation exposure, Shi stresses, which patients prefer.
Older tests involve radioactive material being ingested with a small meal, so that physicians can use X-rays to observe small rings moving through the digestive tract.
How it Works
The SmartPill system consists of a capsule the size of a large vitamin pill containing wireless technology that sends information to a monitor worn by the patient. After ingesting the SmartPill at the doctor’s office, the patient goes home, wearing a monitor for four days. The SmartPill wirelessly transmits a signal to the monitor.
“That signal allows us to determine where the capsule is in the intestine, based on pH, temperature and pressure,” says Harberson. Each time she had a symptom, Barnes says, she would push a button on the monitor. That would let the doctors know where the SmartPill was in her digestive tract at the time she had the symptoms. And that is what revealed what the problem was. After two to five days, the capsule passes out of the body in a bowel movement.
Barnes can attest to the ease of the SmartPill compared to other tests she had.
While the SmartPill did present a few challenges for her, she wouldn’t hesitate to do it again if she needed to. Mainly, for Barnes, the problem was trying to swallow the SmartPill. It took her six tries. She believes it was more of a problem for her because of the six months of illness prior to her diagnosis, which also resulted in acid reflux disease and periodic problems swallowing.
Here is where the SmartPill is so helpful: It can see what normally can’t be seen.
So why isn’t the SmartPill one of the first tests a physician orders?
Harberson of Lancaster Gastroenterology uses the analogy of horses and zebras. In other words, the common versus the uncommon.
“You look for common problems first,” he says. A physician will look first for ulcers, gallbladder disease or inflammation of the intestine, he says.
If one of those diseases isn’t found, then physicians will look for a problem in the movement of food and liquid through the digestive system, what they call motility, Harberson explains.
Usually, the suspicion is that there is slow emptying of the stomach, he says. “There are occasional patients who have normal emptying in the stomach but a delay in the colon [chronic constipation],” says Harberson.
Who it Helps
Here is where the SmartPill is so helpful: It can see what normally can’t be seen.
“Essentially, we can see the very beginning and end of the small intestine,” says Harberson.
“If you think of the intestine being 25 feet long, in an upper endoscopy, you see the first three to four feet, and in a colonoscopy, you see the last four to five feet, and then there’s about 15 to 17 feet we don’t see,” he says. The SmartPill evaluates that part of the small intestine.
The typical digestive tract problems seen in patients are at the beginning and end of the digestive system, Harberson says, such as ulcers, polyps or colon cancer.
But with someone like Hope Barnes, the diagnosis lies in seeing what is happening in that 15 to 17 feet that can’t be seen with older tests.
In the digestive tract, there should always be forward movement to enable digestion, says Harberson. Without that forward movement, people develop the symptoms Barnes had.
With the data from the monitor, a doctor “can evaluate motility through the entire digestive system,” says Harberson, which explained most simply includes the stomach, small intestine and colon.
“Based on the time it takes to move through each of those parts of the intestine, we can tailor medical treatment to treat the patient’s specific problem in the G.I. tract,” says Harberson.
That is what he did for Barnes. She is now on a restricted diet with a medicine to help motility. She says she now has symptoms only a couple of days a month.
Only a small segment of people are given the SmartPill test, says Harberson, but he says, “It has helped determine the best treatment for the patient in a majority of the people we’ve performed the test on.”
Patients like Barnes can go back to living.
“I see him as a life-saver,” she says of Harberson. “I can live an active productive life now.”
