Assessment of autonomic function in untreated adult coeliac disease

Gian Giorgetti

Antonio Tursi

Cesare Iani

Flavio Arciprete

Giovanni Brandimarte

Ambrogio Capria

Luigi Fontana

Gian Marco Giorgetti, Department of Internal Medicine, Clinical Nutrition Unit, “S. Eugenio” Hospital, Rome, Italy

Antonio Tursi, Digestive Endoscopy Unit, “Lorenzo Bonomo” Hospital, Andria (BA), Italy

Cesare Iani, Flavio Arciprete, Division of Neurology, “S. Eugenio” Hospital, Rome, Italy

Giovanni Brandimarte, Department of Internal Medicine, Division of Gastroenterology, “Cristo Re” Hospital, Rome, Italy

Ambrogio Capria, Luigi Fontana, Department of Internal Medicine and Immunology, “Tor Vergata” University, Rome, Italy

Author contributions: All authors contributed equally to the work.

Correspondence to: Dr. Antonio Tursi, Galleria Pisani, 4, 70031 Andria (BA), Italy. ti.ilacsit@isrutotna

Fax: +39-883-290225

Gian Marco Giorgetti, Department of Internal Medicine, Clinical Nutrition Unit, “S. Eugenio” Hospital, Rome, Italy

Antonio Tursi, Digestive Endoscopy Unit, “Lorenzo Bonomo” Hospital, Andria (BA), Italy

Cesare Iani, Flavio Arciprete, Division of Neurology, “S. Eugenio” Hospital, Rome, Italy

Giovanni Brandimarte, Department of Internal Medicine, Division of Gastroenterology, “Cristo Re” Hospital, Rome, Italy

Ambrogio Capria, Luigi Fontana, Department of Internal Medicine and Immunology, “Tor Vergata” University, Rome, Italy

Author contributions: All authors contributed equally to the work.

Correspondence to: Dr. Antonio Tursi, Galleria Pisani, 4, 70031 Andria (BA), Italy. ti.ilacsit@isrutotna

Fax: +39-883-290225

Received 2004 Jan 10; Revised 2004 Jan 29; Accepted 2004 Mar 2.

Abstract

AIM: Some recent studies showed that alteration of upper-gut motility in coeliac disease may be related to dysfunction of autonomic nervous system. The aim of our study was to investigate whether autonomic nervous system was altered in untreated and unselected coeliac disease patients.

METHODS: We studied 8 untreated and consecutive coeliac disease patients (2 males and 6 females, age range 37 ± 14.5 years). Histological evaluation of duodenal mucosa, anti-gliadin antibodies (AGA), antiendomysial antibodies (EMA) and anti-tTG antibodies and sorbitol H2 breath test were performed in all patients. Extrinsic autonomic neuropathy was assessed by the standardized measurement of cardiovascular reflexes (lying-to-standing, Valsalva manoeuvre, deep breathing, sustained handgrip). The results obtained were compared with a healthy, asymptomatic control group (6 males and 7females, age range 42.3 ± 13.5 years).

RESULTS: Coeliac patients exhibited a lower increase of PAS as a response to isometric effort, a reduction of spectral power LF as a response to clinostatic position, but without statistical significance. Also they showed a lower tolerance to orthostatic position, associated with a latent disequilibrium of sympathetic-vagal balance, a relative prevalence of parasympathetic component of the autonomic function. However, these results were not statistically significant when compared with control group (P = n.s.). And they were unchanged after 6 and 12 mo of gluten-free diet.

CONCLUSION: This study failed to confirm a significant correlation between autonomic dysfunction and coeliac disease, yet we could not exclude a role of autonomic dysfunction in the genesis of systemic symptoms in some coeliacs.

Abstract

Abbreviations: IDA: iron-deficiency anaemia.

Abbreviations: AGA: Anti-gliadin antibodies; EMA: anti-endomysium antibodies; anti-tTG: anti-tissue transglutaminase; H2-BT: Hydrogen2-breath test.

LS: Lying-to-standing; VR: Valsalva reaction; DB: Deep breathing.

Footnotes

Edited by Zhu LH and Xu FM

Footnotes

References

1. Catassi C, Rätsch IM, Fabiani E, Rossini M, Bordicchia F, Candela F, Coppa GV, Giorgi PLCoeliac disease in the year 2000: exploring the iceberg. Lancet. 1994;343:200–203.[PubMed][Google Scholar]
2. Lundin KECoeliac disease--all questions answered? Dig Liver Dis. 2002;34:238–242.[PubMed][Google Scholar]
3. Johnston SD, Watson RG, McMillan SA, Sloan J, Love AHPrevalence of coeliac disease in Northern Ireland. Lancet. 1997;350:1370.[PubMed][Google Scholar]
4. Volta U, Bellentani S, Bianchi FB, Brandi G, De Franceschi L, Miglioli L, Granito A, Balli F, Tiribelli CHigh prevalence of celiac disease in Italian general population. Dig Dis Sci. 2001;46:1500–1505.[PubMed][Google Scholar]
5. Tursi A, Giorgetti G, Brandimarte G, Rubino E, Lombardi D, Gasbarrini GPrevalence and clinical presentation of subclinical/silent celiac disease in adults: an analysis on a 12-year observation. Hepatogastroenterology. 2001;48:462–464.[PubMed][Google Scholar]
6. Brandimarte G, Tursi A, Giorgetti GM. Changing trends in clinical form of celiac disease. Which is now the main form of celiac disease in clinical practice? Minerva Gastroenterol Dietol. 2002;48:121–130.[PubMed]
7. Revised criteria for diagnosis of coeliac diseaseReport of Working Group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Child. 1990;65:909–911.[Google Scholar]
8. Green PH, Jabri BCoeliac disease. Lancet. 2003;362:383–391.[PubMed][Google Scholar]
9. O'Mahony S, Howdle PD, Losowsky MSReview article: management of patients with non-responsive coeliac disease. Aliment Pharmacol Ther. 1996;10:671–680.[PubMed][Google Scholar]
10. Holmes GK, Prior P, Lane MR, Pope D, Allan RNMalignancy in coeliac disease--effect of a gluten free diet. Gut. 1989;30:333–338.[Google Scholar]
11. Tursi AGastrointestinal motility disturbances in celiac disease. J Clin Gastroenterol. 2004;38:642–645.[PubMed][Google Scholar]
12. Usai P, Usai Satta P, Lai M, Corda MG, Piras E, Calcara C, Boy MF, Morelli A, Balestrieri A, Bassotti GAutonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. Eur J Clin Invest. 1997;27:1009–1015.[PubMed][Google Scholar]
13. Meuwisse GHDiagnostic criteria in coeliac disease. Acta Paediatr. 1970;59:461–463.[PubMed][Google Scholar]
14. Feighery C, Weir DG, Whelan A, Willoughby R, Youngprapakorn S, Lynch S, O'Moráin C, McEneany P, O'Farrelly CDiagnosis of gluten-sensitive enteropathy: is exclusive reliance on histology appropriate? Eur J Gastroenterol Hepatol. 1998;10:919–925.[PubMed][Google Scholar]
15. Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue') Gastroenterology. 1992;102:330–354.[PubMed]
16. Oberhuber G, Granditsch G, Vogelsang HThe histopathology of coeliac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999;11:1185–1194.[PubMed][Google Scholar]
17. Ewing DJ, Clarke BFDiagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 1982;285:916–918.[Google Scholar]
18. Cardone C, Paiusco P, Marchetti G, Burelli F, Feruglio M, Fedele DCough test to assess cardiovascular autonomic reflexes in diabetes. Diabetes Care. 1990;13:719–724.[PubMed][Google Scholar]
19. Usai P, Usai Satta P, Savarino V, Boy MFAutonomic neuropathy in adult celiac disease. Am J Gastroenterol. 1996;91:1676–1677.[PubMed][Google Scholar]
20. Bharucha AE, Camilleri M, Low PA, Zinsmeister ARAutonomic dysfunction in gastrointestinal motility disorders. Gut. 1993;34:397–401.[Google Scholar]
21. Pengiran Tengah DS, Wills AJ, Holmes GKNeurological complications of coeliac disease. Postgrad Med J. 2002;78:393–398.[Google Scholar]
22. Kaplan JG, Pack D, Horoupian D, DeSouza T, Brin M, Schaumburg HDistal axonopathy associated with chronic gluten enteropathy: a treatable disorder. Neurology. 1988;38:642–645.[PubMed][Google Scholar]
23. Wills A, Hovell CJNeurological complications of enteric disease. Gut. 1996;39:501–504.[Google Scholar]
24. Piha SJ, Puukka P, Seppänen AShort- and long-term reproducibility of cardiovascular tests of autonomic function in normal subjects. Clin Auton Res. 1991;1:115–118.[PubMed][Google Scholar]
25. Nyarko-Adomfeh CThe long-term reproducibility of clinical tests of autonomic cardiovascular function in normal man. Clin Auton Res. 1992;2:257–265.[PubMed][Google Scholar]
26. Luostarinen L, Himanen SL, Luostarinen M, Collin P, Pirttilä TNeuromuscular and sensory disturbances in patients with well treated coeliac disease. J Neurol Neurosurg Psychiatry. 2003;74:490–494.[Google Scholar]