Delayed mouth-caecum transit of a lactulose labelled liquid test meal in patients with steatorrhoea caused by partially treated coeliac disease

• Published in: Gut Vol. 28; no. 10; pp. 1275 - 1282
• Main Authors: Spiller, R C, Lee, Y C, Edge, C, Ralphs, D N, Stewart, J S, Bloom, S R, Silk, D B
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.10.1987; BMJ; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Biological and medical sciences; Breath Tests; Cecum; Celiac Disease - diet therapy; Celiac Disease - metabolism; Celiac Disease - physiopathology; Disaccharides; Female; Gastric Emptying; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Transit; Glutens - administration & dosage; Hormones - metabolism; Humans; Hydrogen - analysis; Lactulose; Male; Medical sciences; Middle Aged; Mouth; Other diseases. Semiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Radionuclide study; Human; Celiac disease; Diet therapy; Partial; Lactulose; Adult; Digestive diseases; Steatorrhea; Digestive transit
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.28.10.1275

Mouth-caecum transit time (M-CTT) of a lactulose labelled liquid test meal has been measured in 27 coeliac patients and 10 healthy controls using the breath hydrogen technique. Although all patients were urged to maintain a gluten free diet, not all did, and there was, therefore, a wide range in the severity of fat malabsorption within the patient group. Gastric emptying of a 113Indium DTPA-labelled liquid test meal was also assessed in separate studies on six healthy controls and 11 of the coeliac patients. Fasting breath hydrogen concentrations and the response to lactulose, as assessed both by the rate of rise, and the peak breath hydrogen concentration reached, showed no difference between coeliacs and controls, regardless of the presence or absence of steatorrhoea. Mouth-caecum transit time in the 16 coeliac patients with steatorrhea (faecal fat greater than 7 g/24 h) was, however, significantly prolonged being 158 +/- 18 minutes (mean +/- SEM), compared with 70 +/- 9 minutes for the controls (p less than 0.02), and 83 +/- 15 minutes for the 11 coeliacs without steatorrhoea (p less than 0.002). Mouth-caecum transit time in the coeliac patients was linearly related to the 24 hour faecal fat excretion, r = 0.55, n = 27, p less than 0.01. Slow mouth-caecum transit in the coeliacs with steatorrhoea was not caused by delayed gastric emptying as the t1/2 for coeliacs with steatorrhoea was within the normal range. Coeliacs with delayed mouth-caecum transit had impaired insulin release but the postprandial profiles of the other peptides measured (cholecystokinin, GIP, secretin, motilin, neurotensin, enteroglucagon, and peptide YY) were all within the normal range in this group of partially treated coeliac patients.