Coleman, N.S.; Holmes, G.K.T.; Dunlop, S.P.; Marciani, L.; Gowland, P.A.; Singh, G.; Marsden, C.A.; Spiller, R.C.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA15
Academic Journal
Background: Anorexia and nausea are common but unexplained features in coeliac disease. We have recently shown that a 5-HT[sub 3] agonist delays gastric emptying and induces nausea in healthy subjects. Untreated coeliacs have marked duodenal enterochromaffin cell hyperplasia and we hypothesised that the postprandial dyspepsia and delayed gastric emptying frequently seen in these patients is due to excess serotonin release following a meal. Methods: Untreated coeliacs (n = 13) and controls (n = 12) received a 500 kcal meal and blood samples were collected during fasting and for 3 hours postprandially. Serotonin was measured in platelet poor plasma using HPLC-EC. The presence of postprandial dyspepsia was assessed using a questionnaire. On a separate occasion gastric volumes and motility were determined by echoplanar magnetic resonance imaging. Results: (Mean ±SE) Serotonin rose significantly after the meal, coeliac patients showing a significantly greater postprandial AUC over 3 hours (4386±622) compared with controls (1756±295 nmol/ L.min, p = 0.001). Peak 5HT levels were also significantly higher in coeliacs (114±26 v 59±27 nmol/L, p < 0.01) and occurred sooner after the meal than in controls (71±16 v 133±9 min, p < 0.01) Coeliacs with significant postprandial dyspepsia n = 7) had higher postprandial 5HT release than those without symptoms (n = 6) (5264±556 v 33611089 nmol/L.min) this difference was not significant (p = 0.13) Gastric emptying in coeliacs was significantly delayed (72±11 v 40±13 min, p = 0.01) but this did not correlate with serotonin levels (r = 0.29). Conclusion: Coeliac disease is associated with markedly elevated postprandial serotonin release, postprandial dyspepsia, and delayed gastric emptying. Whether these are causally linked remains to be determined by intervention studies using 5HT antagonists.


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