Paolo Usai1, Paolo Usai‐Satta1, Maria Letizia Lai1, M Corda1, Enrico Piras1, Calcedonio Calcara2, M. F. Boy1, Andrea Morelli2, A Balestrieri1, Gabrio Bassotti2
1Istituto di Medicina Interna, Università degli Studi di Cagliari, Italy,
2Laboratorio di Motilità Intestinale, Clinica di Gastroenterologia ed Endoscopia Digestiva, Dipartimento di Medicina Clinica, Patologia e Farmacologia, Università di Perugia, Italy
Tóm tắt
There is recent evidence that upper‐gut motor abnormalities may be present in coeliac disease. However, to date, the pathophysiological mechanisms responsible for the above have not been explored. The purpose of the present study was to investigate upper‐gut motor activity in coeliac disease and explore the role played by the autonomic nervous system in motility disturbances. Thirty untreated adult coeliac patients were recruited into the study. Oesophageal manometry and cardiovascular autonomic tests were performed in all patients; oesophageal pH‐metry was carried out in 20 patients, gastrointestinal manometry in eight and scintigraphic gastric emptying in 13. Oesophageal motor abnormalities were detected in about 50% of patients, pH‐metry was abnormal in 30% of them, and up to 75% of coeliac patients displayed gastrointestinal motility alterations. Delayed gastric emptying was documented in about 50% of patients and was correlated with manometric post‐prandial hypomotility. Autonomic tests were positive in 45% of patients as a group, and reached pathological score in 19% of them. Autonomic score correlated significantly with the percentage of bi‐peaked waves and with the number of fasting intestinal clusters. This study confirms that upper‐gut motor abnormalities are frequently present in adult coeliac disease. Extrinsec autonomic neuropathy may play a role, although other pathophysiological mechanisms are likely to occur.
