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.
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Rubin CE, Eidelman S, Weinstein WM: Sprue by any other name. Gastroenterology 58:409–413, 1970
Cooke WT, Holmes GKT: Coeliac Disease. Edinburgh, Churchill Livingstone, 1984
Working Group of European Society of Paediatric Gastroenterology and Nutrition: Revised Criteria for diagnosis of coeliac disease. Arch Dis Child 65:909–911, 1990
Trier JS: Celiac sprue. N Engl J Med 325:1709–1719, 1991
Trier JS: Celiac sprue.In Gastrointestinal Disease, 4th ed. MH Sleisenger, JS Fordtran (eds). Philadelphia, WB Saunders, 1989, pp 1134–1152
Kagnoff MF: Celiac disease.In Textbook of Gastroenterology. T Yamada, DH Alpers, C Owyang, DW Powell, FE Silverstein (eds). Philadelphia, JB Lippincott, 1991, pp 1503–1520
Naish JM, Capper WM, Brown NJ: Intestinal pseudo-obstruction with steatorrhoea. Gut 1:62–66, 1960
McClelland HA, Lewis MJ, Naish JM: Idiopathic steatorrhoea with intestinal pseudoobstruction. Gut 3:142–145, 1962
Ingelfinger FJ: The diagnosis of sprue in non-tropical areas. N Engl J Med 228:180–184, 1963
Dawson DJ, Sciberras CM, Whitwell H: Coeliac disease presenting with intestinal pseudo-obstruction. Gut 25:1003–1008, 1984
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, 1992
Trier JS: Intestinal malabsorption: Differentiation of cause. Hosp Pract 23:195–211, 1988
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, 1988
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, 1988
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, 1986
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, 1987
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, 1990
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, 1991
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, 1992
Fenton TR, Harries JT, Milla PJ: Disordered small intestinal motility: A rational basis for toddler's diarrhoea. Gut 24:897–903, 1983
Tomomasa T, Itoh K, Koizumi T, Kuroume T: Nonmigrating rhythmic activity in the stomach and duodenum of neonates. Biol Neonat 48:1–9, 1985
Milla PJ. Disorders of Gastrointestinal Motility. Chichester, John Wiley & Sons, 1988
Ittmann PI, Amarnath R, Berseth CL: Maturation of antroduodenal motor activity in preterm and term infants. Dig Dis Sci 37:14–19, 1992
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, 1977
Kellow JE, Borody TJ, Phillips SF, Tucker RL, Haddad AC: Human interdigestive motility: Variations in patterns from esophagus to colon. Gastroenterology 91:386–395, 1986
Malagelada JR, Camilleri M, Stanghellini V: Manometric Diagnosis of Gastrointestinal Motility Disorders. New York, Thieme, 1986
Summers RW, Anuras S, Green J: Jejunal manometry patterns in health, partial intestinal obstruction and pseudoobstruction. Gastroenterology 85:1290–1300, 1983
Stanghellini V, Camilleri M, Malagelada JR: Chronic idiopathic intestinal pseudoobstruction: Clinical and intestinal manometric findings. Gut 28:5–12, 1987
Kellow JE, Phillips SF. Altered small bowel motility in irritable bowel syndrome is correlated with symptoms. Gastroenterology 92:1885–1893, 1987
Kerlin P, Phillips SF: Variability of motility of the ileum and jejunum in healthy humans. Gastroenterology 82:694–700, 1982
Bassotti G, Pelli MA, Morelli A: Duodeno-jejunal motor activity in patients with chronic dyspeptic symptoms. J Clin Gastroenterol 12:17–21, 1990
Malagelada JR, Stanghellini V: Manometric evaluation of functional upper gut symptoms. Gastroenterology 88:1223–1231, 1985
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 258–273
Quigley EMM: Intestinal manometry. Technical advances, clinical limitations. Dig Dis Sci 37:10–13, 1992
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, 1992
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, 1975
Kerlin P, Zinsmeister A, Phillips S: Relationship of motility to flow of contents in the human small intestine. Gastroenterology 82:701–706, 1982
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, 1983
Quigley EMM, Thompson JS: The motor response to intestinal resection: motor activity in the canine small intestine following distal resection. Gastroenterology 105:791–798, 1993
Kumar D, Wingate DL: The irritable bowel syndrome: a paroxysmal motor disorder. Lancet 2:973–977, 1985
Kellow JE, Zinsmeister AR, Phillips SF: Dysmotility of the small intestine in irritable bowel syndrome. Gut 29:1236–1243, 1988
Kellow JE, Gill RC, Wingate DL: Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome. Gastroenterology 98:1208–1218, 1990
Schuffler MD, Kaplan LR, Johnson L: Small intestinal mucosa in pseudoobstruction syndromes. Dig Dis Sci 23:821–828, 1978
O'Farrelly C: The spectrum of gluten sensitive disease. Eur J Gastroenterol Hepatol 3:129–135, 1991
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, 1992
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, 1978
Ottaway CA: Neuroimmunomodulation in the intestinal mucosa. Gastroenterol Clin North Am 20:511–529, 1991
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, 1991
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 90
Scott RB, Diamant SC, Gall DG: Motility effects of intestinal anaphylaxis in the rat. Am J Physiol 255:G505-G511, 1988
Diamant SC, Gall DG, Scott RB: The effect of intestinal anaphylaxis on postprandial motility in the rat. Can J Physiol Pharmacol 67:1326–1330, 1989
Scott RB, Gall DG, Maric M: Mediation of food protein-induced intestinal anaphylaxis on rate of transit. Can J Physiol Pharmacol 67:1437–1441, 1989
Crowe SE, Perdue MH: Gastrointestinal food hypersensitivity: Basic mechanisms of pathophysiology. Gastroenterology 103:1075–1095, 1992
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, 1991
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Bassotti, G., Castellucci, G., Betti, C. et al. Abnormal gastrointestinal motility in patients with celiac sprue. Digest Dis Sci 39, 1947–1954 (1994). https://doi.org/10.1007/BF02088130
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DOI: https://doi.org/10.1007/BF02088130