Nottingham Digestive Diseases Centre, University of Nottingham and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
Sheffield Teaching Hospitals NHS Foundation Trust and University of Sheffield, Sheffield, UK.
United European Gastroenterol J. 2019 Dec;7(10):1353-1360. doi: 10.1177/2050640619860372. Epub 2019 Jun 21.
The regular overnight migrating motor complex (MMC) ensures that the normal fasting small-bowel water content (SBWC) is minimised. We have applied our recently validated non-invasive magnetic resonance technique to assess SBWC in newly diagnosed coeliac disease (CD), scleroderma (SCD) and irritable bowel syndrome (IBS), conditions possibly associated with small intestinal bacterial overgrowth (SIBO).
A total of 20 CD and 15 SCD patients with gastrointestinal symptoms were compared to 20 healthy volunteers (HV) and 26 IBS with diarrhoea (IBS-D) patients, as previously reported. All underwent a fasting magnetic resonance imaging (MRI) scan on a 1.5 T Philips Achieva MRI scanner to assess fasting SBWC and colonic volumes. Stool and symptom diaries were completed for one week.
Compared to HV, all patients had significantly increased stool frequency and Bristol stool form score. SBWC was significantly increased in CD (median 109 mL; interquartile range (IQR) 53-224 mL) compared to HV (median 53 mL; IQR 31-98 mL; < 0.01) and IBS-D (median 42 mL; IQR 28-67 mL; < 0.01). A variable increase in SBWC was also found in SCD (median 77 mL; IQR 39-158 mL), but this was not significant ( = 0.2). Colonic volumes were similar for all groups, being a median of 547 mL (IQR 442-786 mL) for CD, 511 mL (453-789 mL) for SCD, 612 mL (445-746 mL) for HV and 521 mL (428-757 mL) for IBS-D. When CD patients were subdivided according to the Marsh classification, the higher grades had larger colonic volumes.
Fasting SBWC as assessed by MRI is significantly increased in newly diagnosed CD and SCD but decreased in IBS-D. Future studies should test whether increased resting fluid predisposes to SIBO.
规律的夜间移行性运动复合波（MMC）可确保正常空腹时小肠内的水分含量（SBWC）最小化。我们应用最近验证的非侵入性磁共振技术，来评估新诊断的乳糜泻（CD）、硬皮病（SCD）和肠易激综合征（IBS）患者的 SBWC，这些疾病可能与小肠细菌过度生长（SIBO）有关。
我们将 20 名有胃肠道症状的 CD 患者和 15 名 SCD 患者与 20 名健康志愿者（HV）和 26 名腹泻型肠易激综合征（IBS-D）患者进行了比较，这些患者的情况此前已经报道过。所有患者均在 1.5T 的飞利浦 Achieva MRI 扫描仪上进行禁食磁共振成像（MRI）扫描，以评估空腹时的 SBWC 和结肠容量。患者完成一周的粪便和症状日记。
与 HV 相比，所有患者的粪便频率和布里斯托粪便形状评分均显著增加。与 HV（中位数 53mL；IQR 31-98mL； < 0.01）和 IBS-D（中位数 42mL；IQR 28-67mL； < 0.01）相比，CD 患者的 SBWC 显著升高（中位数 109mL；IQR 53-224mL； < 0.01）。SCD 患者的 SBWC 也有一定程度的增加（中位数 77mL；IQR 39-158mL），但无统计学意义（ = 0.2）。所有组的结肠容量相似，CD 患者为中位数 547mL（IQR 442-786mL），SCD 患者为中位数 511mL（IQR 453-789mL），HV 为中位数 612mL（IQR 445-746mL），IBS-D 为中位数 521mL（IQR 428-757mL）。当根据 Marsh 分类对 CD 患者进行细分时，较高等级的患者结肠容量更大。
新诊断的 CD 和 SCD 患者的空腹 SBWC 通过 MRI 评估显著增加，但 IBS-D 患者的 SBWC 减少。未来的研究应检测 SBWC 是否增加静止液体会增加 SIBO 的风险。
