ESOPHAGEAL MOTILITY IN ADULT CELIAC-DISEASE

Coeliac sprue is a relatively frequent disease with protean clinical m anifestations. Recent studies suggest that gastrointestinal motor abno rmalities may explain some symptoms complained of by such patients. We investigated whether coeliac patients have oesophageal motor abnormal ities from both a clinical and a physiological point of view. Thirty-s ix consecutive adult sprue subjects (14 during the florid phase and 22 on gluten-free diet) were studied. A clinical questionnaire on gastro intestinal symptoms (with emphasis on those of oesophageal origin) was administered. Moreover, 18 patients (13 on free and five on gluten-fr ee diet) gave their consent for oesophageal manometry and eight subjec ts for pH-metry also. Oesophageal clinical symptoms were compared with those of 144 age- and sex-matched controls from a general population sample, and manometry with that of 34 healthy volunteers. Of coeliac p atients 50% complained of dysphagia (P < 0.001 vs. controls) and 14% n oncardiac chest pain (P = NS vs. controls). Manometric examination sho wed motor abnormalities in 67% of the subjects examined, consisting of nutcracker oesophagus, hypotonic lower oesophageal sphincter associat ed with simultaneous contractions, and frequent repetitive (>3 peaks) contractions. These abnormalities were equally distributed among free and gluten-free diet patients. pH-metry showed only one pathological r eflux out of eight subjects studies. We conclude that patients with co eliac sprue may display abnormal oesophageal motility. This confirms p revious studies suggesting that gastrointestinal motor abnormalities s hould probably be added to the clinical spectrum of the disease.