Chiarioni G, Bassotti G, Germani U, Battaglia E, Brentegani M T, Morelli A, Vantini I
Divisione di Riabilitazione Gastroenterologica, Ospedale Clinicizzato di Valeggio sul Mincio, Università degli Studi di Verona, Italy.
Dig Dis Sci. 1997 Oct;42(10):2100-5. doi: 10.1023/a:1018878703699.
The mechanisms responsible for bowel disturbances in celiac disease are still relatively unknown. Recent reports suggested that small bowel motor abnormalities may be involved in this pathological condition; however, there are no studies addressing small bowel transit in celiac disease before and after a gluten-free diet. We studied the mouth-to-cecum transit time of a caloric liquid meal in a homogeneous group of celiac patients presenting with clinical and biochemical evidence of malabsorption and complaining of diarrhea. Sixteen patients were recruited and investigated by means of hydrogen breath test through ingestion of 20 g lactulose together with an enteral gluten-free diet formula. A urinary D-xylose test was also done in each patient. Both breath tests and D-xylose tests were carried out basally and after a period of gluten-free diet. Twenty healthy volunteers were recruited as a control group and underwent the same breath testing. At the time of the diagnosis, mouth-to-cecum transit time was significantly prolonged in celiacs with respect to controls (243 +/- 10 vs 117 +/- 6 min, P = 0.0001). The D-xylose test was also abnormal (average urinary concentration 2.8 +/- 0.25 g, normal values >4.5). No correlation was found in patients between mouth-to-cecum transit time and urinary D-xylose output (r = 0.22). After the gluten-free diet period, mouth-to-cecum transit time in celiacs was significantly reduced compared to prediet transit (134 +/- 8 vs 243 +/- 10 min, P = 0.0001) and did not show statistical difference when compared to that found in controls (P = 0.1). The D-xylose test reverted to normal in all but two subjects, who were found to be noncompliant with the diet. Mouth-to-cecum transit time is significantly prolonged in patients affected by untreated celiac disease when compared to healthy controls. This alteration might not be correlated to intestinal malabsorption, and the prolonged orocecal transit could be due to impaired small bowel function (deranged motility?). Since intestinal transit returned to normal values after an adequate gluten-free period, a link with severe active mucosal lesions is suggestive.
乳糜泻中肠道功能紊乱的发病机制仍相对不明。近期报告提示，小肠运动异常可能参与了这一病理状况；然而，尚无关于乳糜泻患者在无麸质饮食前后小肠转运情况的研究。我们研究了一组临床表现和生化指标均显示存在吸收不良且伴有腹泻症状的乳糜泻患者摄入含热量流食后的口腔至盲肠转运时间。招募了16例患者，通过摄入20 g乳果糖并结合无麸质肠内饮食配方，采用氢呼气试验进行研究。同时对每位患者进行了尿D-木糖试验。呼气试验和D-木糖试验均在基线时及无麸质饮食一段时间后进行。招募了20名健康志愿者作为对照组，进行相同的呼气试验。诊断时，乳糜泻患者的口腔至盲肠转运时间相较于对照组显著延长（243±10 vs 117±6分钟，P = 0.0001）。D-木糖试验也异常（尿平均浓度2.8±0.25 g，正常值>4.5）。患者的口腔至盲肠转运时间与尿D-木糖排出量之间未发现相关性（r = 0.22）。无麸质饮食期后，乳糜泻患者的口腔至盲肠转运时间相较于饮食前显著缩短（134±8 vs 243±10分钟，P = 0.0001），与对照组相比无统计学差异（P = 0.1）。除两名未严格遵循饮食的受试者外，所有患者的D-木糖试验均恢复正常。与健康对照组相比，未经治疗的乳糜泻患者的口腔至盲肠转运时间显著延长。这种改变可能与肠道吸收不良无关，而口盲肠转运时间延长可能是由于小肠功能受损（动力紊乱？）。由于在充足的无麸质饮食期后肠道转运恢复至正常水平，提示与严重的活动性黏膜病变有关。
