Department of Pathophysiology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.
Department of Gastroenterology and Hepatology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland.
J Physiol Pharmacol. 2023 Apr;74(2). doi: 10.26402/jpp.2023.2.06. Epub 2023 Jul 10.
The pathogenesis of celiac disease is associated with an autoimmune process. The disease causes chronic inflammation of the small intestinal mucosa, which may affect the brain-gut axis. The activation of visceral receptors (gastrointestinal mechanoreceptor and osmoreceptor) in response to stomach distension caused by water ingestion has not been studied before. Our results showed reduced responsiveness of the autonomic nervous system to water ingestion in patients with celiac disease, which may lead to disturbances of gastric myoelectrical activity and depends on baseline autonomic activity. Water intake can induce gastric distension and motility response, without changes in gastrointestinal hormones. It can also increase the activity of the autonomic nervous system. On the other hand, inflammation in celiac disease (CeD) can alter visceral perception (increase sensitization), leading to autonomic dysfunction. We aimed to investigate the effect of water ingestion on autonomic activity measured as heart rate variability (HRV) and gastric myoelectrical activity measured by electrogastrography (EGG) in patients with CeD. The study included 53 patients with CeD and 50 healthy controls: mean (SD) age, 43.4 (14.8) years and 44.1 (9.2) years, respectively. Electrocardiography with HRV analysis and simultaneous 4-channel EGG was performed before and after the water load test (WLT) ingestion 500-ml water over 5 minutes. We found that compared with controls, at fasting, patients with CeD showed a reduced percentage of normogastria (P=0.045) and an average percentage of slow wave coupling (P<0.01) with increased dominant power (DP) (P<0.001). Moreover, water ingestion in CeD patients reduced the percentage of gastric arrhythmia (P<0.01) and increased the percentage of normogastria (P<0.01) and DP (P<0.01). Finally, in the CeD group, water ingestion increased HRV indices: low frequency by 116.9% (P<0.001), high frequency by 125.3% (P<0.01), but they did not reach the values of the control group. Patients with CeD showed a smaller increase in parasympathetic autonomic activity after the WLT than controls. Altered autonomic responsiveness may contribute to the disturbances of gastric myoelectrical activity and depends on baseline autonomic activity.
乳糜泻的发病机制与自身免疫过程有关。这种疾病会导致小肠黏膜的慢性炎症，这可能会影响脑-肠轴。以前没有研究过水摄入引起的胃部扩张对内脏受体（胃肠道机械感受器和渗透压感受器）的激活作用。我们的研究结果显示，乳糜泻患者对水摄入的自主神经系统反应性降低，这可能导致胃电活动紊乱，且这种紊乱依赖于基线自主神经活动。水摄入可引起胃扩张和运动反应，而不会改变胃肠激素。它还可以增加自主神经系统的活动。另一方面，乳糜泻（CeD）中的炎症可以改变内脏感知（增加致敏），导致自主神经功能障碍。我们旨在研究水摄入对自主活动（通过心率变异性[HRV]测量）和胃电活动（通过胃电图[EGG]测量）的影响，在乳糜泻患者中进行 CeD。该研究包括 53 名乳糜泻患者和 50 名健康对照者：平均（SD）年龄分别为 43.4（14.8）岁和 44.1（9.2）岁。在 5 分钟内摄入 500 毫升水的水负荷试验（WLT）前后，进行心电图和同时进行的 4 通道 EGG 分析。我们发现，与对照组相比，空腹时，CeD 患者表现出正常胃节律的百分比降低（P=0.045）和慢波耦合的平均百分比降低（P<0.01），而主导功率（DP）增加（P<0.001）。此外，CeD 患者在摄入水后，胃心律失常的百分比降低（P<0.01），正常胃节律的百分比增加（P<0.01），DP 增加（P<0.01）。最后，在 CeD 组中，水摄入增加了 HRV 指数：低频增加 116.9%（P<0.001），高频增加 125.3%（P<0.01），但仍未达到对照组的水平。乳糜泻患者在 WLT 后副交感自主神经活动的增加幅度小于对照组。自主反应的改变可能导致胃电活动的紊乱，且这种紊乱依赖于基线自主神经活动。
