celiac patients.pdfVIP

Slow gallbladder emptying reverts to normal but small intestinal transit of a physiological meal remains slow in celiac patients during gluten-free diet F. BENINI, A. MORA, D. TURINI, S. BERTOLAZZI, F. LANZAROTTO, C. RICCI, V. VILLANACCI,* G. BARBARA, V. STANGHELLINI A. LANZINI *Gastroenterology Unit and Histopathology Unit, University and Spedali Civili of Brescia, Brescia, Italy Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy Abstract Background Alterations of small intestinal transit and gallbladder (GB) motility have been reported in celiac disease (CD) in studies involving, in most cases, non-physiological experimental conditions and artifi- cial stimuli to motility. Our aims were to quantitate non-invasively small intestinal transit time and GB emptying during administration of a physiological and palatable solid meal, and to assess the effect of gluten- free diet (GFD). Methods We simultaneously mea- sured mouth-to-cecum transit time (MCTT) using a validated H2 breath test, and GB motility using ultra- sonography. We studied CD patients before (n = 19) and during (n = 14) GFD, and healthy volunteers (n = 24) following administration of a physiological solid meal (Kcal 539). Key Results Mouth-to-cecum transit time was more prolonged in CD (mean ± SEM: 235 ± 96 min) than in controls (169 ± 65 min, P = 0.0039). The GB fasting volume and postprandial residual volume were significantly higher in CD than in controls, and GB emptying constant was slower in CD than in controls. During GFD, GB emptying reverted to normal, but MCTT remained unchanged (229 ± 69 min) and more prolonged in CD than in controls (P = 0.0139). During GFD, duodenal infiltra- tion with lymphocytes and mast cells persisted higher than that in controls, and the number of mast cells lying in proximity of nervous endings did not change. Conclusions Inferences Slow postprandial MCTT in response to a physiological meal does not revert to normal during