Rönnblom A, Andersson S, Danielsson A
Department of Medicine, Central Hospital, Boden, Sweden.
Eur J Gastroenterol Hepatol. 1998 Jul;10(7):607-10. doi: 10.1097/00042737-199807000-00015.
Gastrointestinal (GI) symptoms are common in myotonic dystrophy (MD). Diarrhoea is one of the more disabling of these GI complaints. The mechanisms behind diarrhoea in MD have not previously been investigated systematically.
To elucidate the mechanisms behind diarrhoea in MD.
Twenty patients with MD and suffering from diarrhoea were investigated in order to detect malabsorption (blood tests and faecal fat excretion) and bile acid malabsorption ([75Se]selenahomocholic acid-taurine (SeHCAT) retention) and to study intestinal morphology (duodenal and rectal biopsies).
Two patients had deficiency of folic acid and four showed reduced levels of pancreatic isoamylase, but none of them had steatorrhoea. Two out of eight patients had abnormal bile acid breath tests with normal SeHCAT, indicating small bowel bacterial overgrowth and 12 displayed reduced SeHCAT retention. Duodenal biopsies were normal in eight patients and five out of nine rectal biopsies displayed slight inflammation.
A possible mechanism of diarrhoea in MD could be identified in most of the patients. Bile acid malabsorption seems to be a frequent cause and can be treated successfully.
胃肠道（GI）症状在强直性肌营养不良（MD）中很常见。腹泻是这些胃肠道不适中更具致残性的症状之一。MD患者腹泻背后的机制此前尚未得到系统研究。
阐明MD患者腹泻背后的机制。
对20例患有MD且有腹泻症状的患者进行调查，以检测吸收不良（血液检查和粪便脂肪排泄）和胆汁酸吸收不良（[75硒]硒代高胆酸-牛磺酸（SeHCAT）潴留），并研究肠道形态（十二指肠和直肠活检）。
2例患者叶酸缺乏，4例患者胰腺异淀粉酶水平降低，但均无脂肪泻。8例患者中有2例胆汁酸呼气试验异常而SeHCAT正常，提示小肠细菌过度生长，12例患者SeHCAT潴留减少。8例患者十二指肠活检正常，9例直肠活检中有5例有轻度炎症。
大多数MD患者腹泻的可能机制可以确定。胆汁酸吸收不良似乎是常见原因，且可成功治疗。
