Bai J C, Mauriño E, Martínez C, Vázquez H, Niveloni S, Soifer G, Flores D, Boerr L A
Clinical Service, Hospital de Gastroenterología C, Buenos Aires, Argentina.
Acta Gastroenterol Latinoam. 1995;25(5):277-84.
Motility disorders of the digestive tract have long been implicated in the pathophysiology of diarrhea in patients with celiac sprue. However, the contribution of the colon to the intestinal transit of celiac sprue has not been reported. Our aim was to determine whether sprue alters gut transit and whether differences in the clinical status of the disease influences colonic transit. We prospectively studied 25 patients with untreated celiac sprue, 15 treated patients and 15 healthy controls. Oro-cecal transit time, measured by the lactulose breath H2 test, was significantly delayed in untreated patients compared with treated patients and controls (p < 0.001 and p < 0.01 respectively). The delayed transit through the stomach and small bowel was not related to the presence of the steatorrhea. Transit of radiopaque makers, a measure of total colonic transit, was significantly faster in untreated patients (p < 0.05). The major finding was that this abnormal colonic behavior was principally due to a subpopulation of untreated patients with very fast transit times (< 18 hours). A weakly significant inverse correlation between transit and fecal weight (r: -0.55, p < 0.01), and between transit and steatorrhea (r: -0.38, p < 0.05), was observed. We confirm previous descriptions of delayed oro-cecal transit time in untreated patients, and also provide the first evidence that disordered colonic transit contributes to the pathophysiology of the diarrhea in sprue.
长期以来，消化道运动障碍一直被认为与乳糜泻患者腹泻的病理生理学有关。然而，结肠在乳糜泻肠道转运中的作用尚未见报道。我们的目的是确定乳糜泻是否会改变肠道转运，以及疾病临床状态的差异是否会影响结肠转运。我们前瞻性地研究了25例未经治疗的乳糜泻患者、15例已治疗患者和15名健康对照者。通过乳果糖呼气氢试验测量的口盲肠转运时间，未经治疗的患者与已治疗患者及对照者相比显著延迟（分别为p < 0.001和p < 0.01）。胃和小肠的转运延迟与脂肪泻的存在无关。不透X线标志物的转运，即总结肠转运的一项指标，在未经治疗的患者中显著更快（p < 0.05）。主要发现是，这种异常的结肠行为主要归因于一小部分未经治疗且转运时间非常快（< 18小时）的患者。观察到转运与粪便重量之间存在弱显著的负相关（r：-0.55，p < 0.01），以及转运与脂肪泻之间存在负相关（r：-0.38，p < 0.05）。我们证实了之前关于未经治疗患者口盲肠转运时间延迟的描述，并且还首次提供了证据表明结肠转运紊乱促成了乳糜泻腹泻的病理生理学。
