Advertisement

Digestive Diseases and Sciences

, Volume 39, Issue 9, pp 1947–1954 | Cite as

Abnormal gastrointestinal motility in patients with celiac sprue

  • Gabrio Bassotti
  • Giuseppe Castellucci
  • Cesare Betti
  • Carla Fusaro
  • Maria Lucia Cavalletti
  • Alberto Bertotto
  • Fabrizio Spinozzi
  • Antonio Morelli
  • Maria Antonietta Pelli
Motility, Nerve-Gut Interactions, Hormones, And Receptors

Abstract

No study to date has objectively investigated whether the motor behavior of the small bowel is abnormal in celiac sprue. The purpose of this study was to systematically address this topic by means of intraluminal pressure recordings in a series of such patients. Sixteen subjects (nine adults, seven children, age range 2–69 years) with celiac sprue were recruited and studied while untreated. Manometric examination was carried out for 6 hr during fasting and 3 hr after a meal. Adult celiac patients displayed a significantly (mean ±sem) greater frequency of migrating motor complexes in comparison to controls during fasting (4.44±1.6 vs 2.45±0.20,P<0.01), whereas no differences were found in the pediatric group with respect to this variable. Fasting motor abnormalities, chiefly represented by discrete clustered contractions, giant jejunal contractions, and bursts of nonpropagated contractions, were discovered in a high percentage in both groups of celiac subjects (89% in adults and 44% in children, respectively). Similar abnormalities were observed in the postprandial period, especially in adults. In conclusion, patients with celiac sprue frequently display discrete gastrointestinal motor abnormalities, which though perhaps nonspecific may account for several symptoms complained of by such patients.

Key words

celiac sprue intestinal motility 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Rubin CE, Eidelman S, Weinstein WM: Sprue by any other name. Gastroenterology 58:409–413, 1970PubMedGoogle Scholar
  2. 2.
    Cooke WT, Holmes GKT: Coeliac Disease. Edinburgh, Churchill Livingstone, 1984Google Scholar
  3. 3.
    Working Group of European Society of Paediatric Gastroenterology and Nutrition: Revised Criteria for diagnosis of coeliac disease. Arch Dis Child 65:909–911, 1990Google Scholar
  4. 4.
    Trier JS: Celiac sprue. N Engl J Med 325:1709–1719, 1991PubMedGoogle Scholar
  5. 5.
    Trier JS: Celiac sprue.In Gastrointestinal Disease, 4th ed. MH Sleisenger, JS Fordtran (eds). Philadelphia, WB Saunders, 1989, pp 1134–1152Google Scholar
  6. 6.
    Kagnoff MF: Celiac disease.In Textbook of Gastroenterology. T Yamada, DH Alpers, C Owyang, DW Powell, FE Silverstein (eds). Philadelphia, JB Lippincott, 1991, pp 1503–1520Google Scholar
  7. 7.
    Naish JM, Capper WM, Brown NJ: Intestinal pseudo-obstruction with steatorrhoea. Gut 1:62–66, 1960PubMedGoogle Scholar
  8. 8.
    McClelland HA, Lewis MJ, Naish JM: Idiopathic steatorrhoea with intestinal pseudoobstruction. Gut 3:142–145, 1962Google Scholar
  9. 9.
    Ingelfinger FJ: The diagnosis of sprue in non-tropical areas. N Engl J Med 228:180–184, 1963Google Scholar
  10. 10.
    Dawson DJ, Sciberras CM, Whitwell H: Coeliac disease presenting with intestinal pseudo-obstruction. Gut 25:1003–1008, 1984PubMedGoogle Scholar
  11. 11.
    Stanghellini V, Corinaldesi R, Ghidini C, Ricci Maccarini M, De Giorgio R, Biasco G, Brillanti S, Paparo GF, Barbara L: Reversibility of gastrointestinal motor abnormalities in chronic intestinal pseudo-obstruction. Hepato-Gastroenterology 39:34–38, 1992PubMedGoogle Scholar
  12. 12.
    Trier JS: Intestinal malabsorption: Differentiation of cause. Hosp Pract 23:195–211, 1988Google Scholar
  13. 13.
    Brocchi E, Corazza GR, Caletti G, Treggiari EA, Barbara L, Gasbarrini G: Endoscopic demonstration of loss of duodenal folds in the diagnosis of celiac disease. N Engl J Med 319:741–744, 1988PubMedGoogle Scholar
  14. 14.
    Jabbari M, Wild G, Goresky CA, Daly DS, Lough JO, Cleland DP, Kinnear DG: Scalloped valvulae conniventes; an endoscopic marker of celiac sprue. Gastroenterology 95:1518–1522, 1988PubMedGoogle Scholar
  15. 15.
    Narducci F, Bassotti G, Granata MT, Gaburri M, Farroni F, Palumbo R, Morelli A: Functional dyspepsia and chronic idiopathic gastric stasis. Role of endogenous opiates. Arch Intern Med 146:716–720, 1986PubMedGoogle Scholar
  16. 16.
    Bassotti G, Gaburri M, Clausi GG, Pelli MA, Morelli A: Can idiopathic megacolon cause functional motor abnormalities in the upper gastrointestinal tract? Hepato Gastroenterology 4:186–189, 1987Google Scholar
  17. 17.
    Bassotti G, Gullà P, Betti C, Whitehead WE, Morelli A: Manometric evaluation of jejunal limb after total gastrectomy and Roux-Orr anastomosis for gastric cancer. Br J Surg 77:1025–1029, 1990PubMedGoogle Scholar
  18. 18.
    Bassotti G, Bucaneve G, Betti C, Patoia L, Baratta E, Maresca V, Pelli MA, Morelli A, Del Favero A: Effects of parenteral diclofenac sodium on upper gastrointestinal motility after food in man. Eur J Clin Pharmacol 41:497–500, 1991PubMedGoogle Scholar
  19. 19.
    Bassotti G, Pagliacci MC, Nicoletti I, Pelli MA, Morelli A: Intestinal pseudoobstruction secondary to hypothyroidism. Importance of small bowel manometry. J Clin Gastroenterol 14:56–58, 1992PubMedGoogle Scholar
  20. 20.
    Fenton TR, Harries JT, Milla PJ: Disordered small intestinal motility: A rational basis for toddler's diarrhoea. Gut 24:897–903, 1983PubMedGoogle Scholar
  21. 21.
    Tomomasa T, Itoh K, Koizumi T, Kuroume T: Nonmigrating rhythmic activity in the stomach and duodenum of neonates. Biol Neonat 48:1–9, 1985PubMedGoogle Scholar
  22. 22.
    Milla PJ. Disorders of Gastrointestinal Motility. Chichester, John Wiley & Sons, 1988Google Scholar
  23. 23.
    Ittmann PI, Amarnath R, Berseth CL: Maturation of antroduodenal motor activity in preterm and term infants. Dig Dis Sci 37:14–19, 1992PubMedGoogle Scholar
  24. 24.
    Vantrappen G, Janssens J, Hellemans J, Ghoos Y: The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine. J Clin Invest 59:1158–1166, 1977PubMedGoogle Scholar
  25. 25.
    Kellow JE, Borody TJ, Phillips SF, Tucker RL, Haddad AC: Human interdigestive motility: Variations in patterns from esophagus to colon. Gastroenterology 91:386–395, 1986PubMedGoogle Scholar
  26. 26.
    Malagelada JR, Camilleri M, Stanghellini V: Manometric Diagnosis of Gastrointestinal Motility Disorders. New York, Thieme, 1986Google Scholar
  27. 27.
    Summers RW, Anuras S, Green J: Jejunal manometry patterns in health, partial intestinal obstruction and pseudoobstruction. Gastroenterology 85:1290–1300, 1983PubMedGoogle Scholar
  28. 28.
    Stanghellini V, Camilleri M, Malagelada JR: Chronic idiopathic intestinal pseudoobstruction: Clinical and intestinal manometric findings. Gut 28:5–12, 1987PubMedGoogle Scholar
  29. 29.
    Kellow JE, Phillips SF. Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology 92:1885–1893, 1987PubMedGoogle Scholar
  30. 30.
    Kerlin P, Phillips SF: Variability of motility of the ileum and jejunum in healthy humans. Gastroenterology 82:694–700, 1982PubMedGoogle Scholar
  31. 31.
    Bassotti G, Pelli MA, Morelli A: Duodeno-jejunal motor activity in patients with chronic dyspeptic symptoms. J Clin Gastroenterol 12:17–21, 1990PubMedGoogle Scholar
  32. 32.
    Malagelada JR, Stanghellini V: Manometric evaluation of functional upper gut symptoms. Gastroenterology 88:1223–1231, 1985PubMedGoogle Scholar
  33. 33.
    Stanghellini V, Corinaldesi R, Ghidini C, Ricci Maccarini M, Barbara L: Methodology of gastroduodenal manometry.In Clinical Investigation of Gastric Function. Frontiers in Gastrointestinal Research. C Scarpignato, G Bianchi Porro (eds). Basel, Karger, 1990, pp 258–273Google Scholar
  34. 34.
    Quigley EMM: Intestinal manometry. Technical advances, clinical limitations. Dig Dis Sci 37:10–13, 1992PubMedGoogle Scholar
  35. 35.
    McIntyre AS, Ng DPK, Smith JA, Amoath J, Long RG: The endoscopic appearance of duodenal folds is predictive of untreated adult celiac disease. Gastrointest Endosc 38:148–151, 1992PubMedGoogle Scholar
  36. 36.
    Bueno L, Fioramonti J, Ruckebusch Y: Rate of flow of digesta and electrical activity of the small intestine in dogs and sheep. J Physiol (London) 249:69–85, 1975PubMedGoogle Scholar
  37. 37.
    Kerlin P, Zinsmeister A, Phillips S: Relationship of motility to flow of contents in the human small intestine. Gastroenterology 82:701–706, 1982PubMedGoogle Scholar
  38. 38.
    Remington M, Malagelada JR, Zinsmeister A, Fleming CR: Abnormalities in gastrointestinal motor activity in patients with short bowels: effect of a synthetic opiate. Gastroenterology 85:29–36, 1983Google Scholar
  39. 39.
    Quigley EMM, Thompson JS: The motor response to intestinal resection: motor activity in the canine small intestine following distal resection. Gastroenterology 105:791–798, 1993PubMedGoogle Scholar
  40. 40.
    Kumar D, Wingate DL: The irritable bowel syndrome: a paroxysmal motor disorder. Lancet 2:973–977, 1985PubMedGoogle Scholar
  41. 41.
    Kellow JE, Zinsmeister AR, Phillips SF: Dysmotility of the small intestine in irritable bowel syndrome. Gut 29:1236–1243, 1988PubMedGoogle Scholar
  42. 42.
    Kellow JE, Gill RC, Wingate DL: Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome. Gastroenterology 98:1208–1218, 1990PubMedGoogle Scholar
  43. 43.
    Schuffler MD, Kaplan LR, Johnson L: Small intestinal mucosa in pseudoobstruction syndromes. Dig Dis Sci 23:821–828, 1978Google Scholar
  44. 44.
    O'Farrelly C: The spectrum of gluten sensitive disease. Eur J Gastroenterol Hepatol 3:129–135, 1991Google Scholar
  45. 45.
    Marsh MN: Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity (“celiac sprue”). Gastroenterology 102:330–354, 1992PubMedGoogle Scholar
  46. 46.
    Besterman HS, Bloom SR, Sarson DL, Blackburn AM, Johnston DI, Patel HR, Stewart JS, Modigliani R, Guerin S, Mallinson CN: Gut-hormone profile in coeliac disease. Lancet 1:785–788, 1978PubMedGoogle Scholar
  47. 47.
    Ottaway CA: Neuroimmunomodulation in the intestinal mucosa. Gastroenterol Clin North Am 20:511–529, 1991PubMedGoogle Scholar
  48. 48.
    Spinozzi F, Bassotti G, Cimignoli E, Broccucci L, Morelli A, Grignani F: Intestinal manometry as a new diagnostic tool in food allergy. Schweiz Med Wochenschr 121(suppl. 40/I):56, 1991Google Scholar
  49. 49.
    Bassotti G, Broccucci L, Bistoni O, Morelli A, Vascotto E, Grignani F, Spinozzi F: Diagnostic problems in adult food allergy. Proceedings of the 5th International Symposium on Immunological and Clinical Problems of Food Allergy, Milan, Italy, 1992, p 90Google Scholar
  50. 50.
    Scott RB, Diamant SC, Gall DG: Motility effects of intestinal anaphylaxis in the rat. Am J Physiol 255:G505-G511, 1988PubMedGoogle Scholar
  51. 51.
    Diamant SC, Gall DG, Scott RB: The effect of intestinal anaphylaxis on postprandial motility in the rat. Can J Physiol Pharmacol 67:1326–1330, 1989PubMedGoogle Scholar
  52. 52.
    Scott RB, Gall DG, Maric M: Mediation of food protein-induced intestinal anaphylaxis on rate of transit. Can J Physiol Pharmacol 67:1437–1441, 1989PubMedGoogle Scholar
  53. 53.
    Crowe SE, Perdue MH: Gastrointestinal food hypersensitivity: Basic mechanisms of pathophysiology. Gastroenterology 103:1075–1095, 1992PubMedGoogle Scholar
  54. 54.
    Bassotti G, Pelli MA, Ribacchi R, Miglietti M, Cavalletti ML, Rossodivita ME, Giovenali P, Morelli A:Giardia lamblia infestation reveals underlying Whipple's disease in a patient with longstanding constipation. Am J Gastroenterol 86:371–374, 1991PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1994

Authors and Affiliations

  • Gabrio Bassotti
    • 1
  • Giuseppe Castellucci
    • 1
  • Cesare Betti
    • 1
  • Carla Fusaro
    • 1
  • Maria Lucia Cavalletti
    • 1
  • Alberto Bertotto
    • 1
  • Fabrizio Spinozzi
    • 1
  • Antonio Morelli
    • 1
  • Maria Antonietta Pelli
    • 1
  1. 1.From the Laboratorio di Motilità Intestinale, Clinica di Gastroenterologia ed Endoscopia Digestiva, Dipartimento di Medicina Clinica, Patologia e Farmacologia; Istituto di Clinica Pediatrica; Istituto di Medicina Interna e Scienze OncologicheUniversità degli Studi di PerugiaPerugiaItaly

Personalised recommendations