Duodenal Secretomotor Function in Untreated Coeliac Disease

Abstract

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 < 10cm in the controls; p < 0.01), and there was no significant net bicarbonate absorption (5.6 ± 3.4 versus 27.5 ± 4.4 μmol/min < 10cm 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.

Key Words:

• Bicarbonate transport
• chloride secretion
• coeliac disease
• duodenum
• enteric nerves
• intestinal motility
• intestinal secretion