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Duodenal secretomotor function in untreated coeliac disease
A Mellander1, H Abrahamsson, H Sjövall
1Dept. of Internal Medicine, University of Göteborg, Sweden.
Background:
The aim of the study was to characterize the epithelial transport properties of the distal duodenal mucosa in untreated coeliac disease.
Methods:
The study was performed in 20 patients and in 22 healthy controls. Net fluid and bicarbonate transport was measured with a triple-lumen perfusion technique. Interdigestive motility was recorded by manometry, and the transmural potential difference (PD) was measured as an indicator of electrogenic anion secretion.
Results:
In the patients a net fluid secretion was seen (-1.04 +/- 0.26 versus 0.12 +/- 0.11 ml/min x 10 cm in the controls; p < 0.01), and there was no significant net bicarbonate absorption (5.6 +/- 3.4 versus 27.5 +/- 4.4 mumol/min x 10 cm in the controls; p < 0.001). The epithelial transport rate varied with the interdigestive motility; a shift in the secretory direction was seen in late phase II of the migrating motor complex (MMC). Moreover, the MMC-related PD curve was significantly displaced in the lumen-negative direction (p < 0.001 versus controls).
Conclusions:
The results suggest that in untreated coeliac disease, active chloride secretion is enhanced, and Na+/H+ exchange is reduced. This remodelled mucosa still seems to respond to neurogenic stimuli, as suggested by the presence of MMC-related changes in secretion rate.