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Relation between fat malabsorption and transit abnormalities in human carcinoid diarrhea

S B Saslow¹, M Camilleri, G M Thomforde

¹Gastroenterology Research Unit, Mayo Clinic, Rochester, Minnesota, USA.

Gastroenterology

|February 1, 1996

Summary

Carcinoid diarrhea with rapid transit and steatorrhea does not appear to impair gastric emptying. The ileal and colonic brakes, which normally slow digestion, do not seem to be delayed in these patients.

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Area of Science:

Gastroenterology
Endocrinology
Oncology

Background:

Distal bowel fat and complex carbohydrates trigger inhibitory "brakes" on upper gastrointestinal motility.
Carcinoid syndrome can cause diarrhea and steatorrhea, potentially affecting gut motility.
The role of these "brakes" in carcinoid diarrhea with impaired gastric emptying was unclear.

Purpose of the Study:

To investigate if rapid transit carcinoid diarrhea, associated with steatorrhea, impairs gastric emptying.
To test the hypothesis that upper gut motility is inhibited in patients with carcinoid diarrhea.

Main Methods:

Studied 15 patients with carcinoid diarrhea and limited or no prior gastrointestinal resection.
Assessed gastrointestinal transit using scintigraphy with a standardized meal.
Quantified percentage of ingested fat excretion and measured 24-hour urine 5-hydroxyindoleacetic acid levels.

Main Results:

Most patients (14/15) exhibited accelerated small bowel transit, and all (15/15) had accelerated colonic transit.
Increased stool weight and fat excretion (mean 13%) were observed in most patients.
Gastric emptying showed varied results: prolonged lag time in 2, accelerated in 5, normal in 7, and delayed in 3 patients.

Conclusions:

Ileal and colonic "brakes" do not appear to significantly delay gastric emptying in carcinoid diarrhea patients.
Rapid transit and mild-to-moderate steatorrhea in carcinoid diarrhea do not necessarily lead to impaired gastric emptying.