motilin and Celiac-Disease

There is increasing evidence that digestive hormones are involved in the regulation of the gastrointestinal motor profile in man. A typical profile of postprandial activity corresponding to the continuous occurrence of irregular contractions propagated over short distance is accompanied by an increase in plasma level of 8 to 10 identified digestive hormones. Four of them (insulin, gastrin, neurotensin and CCK8) infused systemically may produce or prolong this typical "fed" pattern suggesting that they may be involved physiologically in the initiation and duration of the fed pattern. The fasted state is characterized by the cyclic occurrence of gastrointestinal migrating motor complexes (MMC) which are associated with cyclic changes in plasma levels of motilin, somatostatin pancreatic polypeptide and gastrin. Numerous recent findings support the hypothesis that an increase in motilin initiates the MMC at foregut level which, in turn, produces the release of somatostatin. These hormones may be responsible for the aboral migration of MMC from the duodenum to the ileum and for the cycling rhythm by affecting blood levels of motilin (and/or) pancreatic polypeptide.

Topics: Animals; Celiac Disease; Circadian Rhythm; Diarrhea; Dogs; Gastrointestinal Hormones; Gastrointestinal Motility; Humans; Motilin; Pancreatic Hormones

Celiac disease (CD) is characterized by mucosal villous atrophy mostly confined to the proximal small intestine. Upper-gut motor abnormalities have been reported. Motilin, localized in cells in the proximal small intestine, is a trigger factor for the migrating motor complex. Plasma levels of motilin were studied in 16 untreated CD patients and in an age-matched control group of 18 healthy subjects by radioimmunoassay and by high-performance liquid chromatography (HPLC). The fasting levels of motilin and postprandial levels were significantly higher in CD patients compared to controls (P<0.01) and HPLC revealed a divergent individual pattern of the motilin fragments.

Topics: Adult; Aged; Case-Control Studies; Celiac Disease; Chromatography, High Pressure Liquid; Fasting; Female; Humans; Male; Middle Aged; Motilin; Postprandial Period; Radioimmunoassay

Topics: Adolescent; Biopsy; Celiac Disease; Child; Child, Preschool; Female; Glutens; Humans; Immunoenzyme Techniques; Infant; Intestinal Mucosa; Jejunum; Male; Motilin

A quantitative morphological investigation of eight endocrine cell types in mucosal biopsies from adults with untreated celiac sprue was undertaken. The quantitative data expressed as cells per millimeter of epithelium most accurately reflected the changes seen in celiac disease, as it takes into account changes in mucosal thickness due to the absence of villi in celiac biopsies. The results showed significant increases in the number of cholecystokinin and enterochromaffin cells, a significant decrease in somatostatin, gastric inhibitory polypeptide and secretin cells, and no change in the motilin, gastrin, and glicentin cells. Significant changes in cell size (cross-sectional area) were also demonstrated in the somatostatin and gastrin cells which were smaller in the celiac biopsies.

Topics: Adult; Aged; Celiac Disease; Cell Count; Cholecystokinin; Duodenum; Enterochromaffin Cells; Female; Gastric Inhibitory Polypeptide; Gastrointestinal Hormones; Glucagon; Humans; Intestinal Mucosa; Male; Middle Aged; Motilin; Proglucagon; Protein Precursors; Secretin; Somatostatin

To test the discriminatory potential of certain indices of pancreatic function we performed duodenal perfusion studies and measured trypsin, bicarbonate, and lactoferrin outputs, and plasma concentrations of pancreatic polypeptide and motilin in the basal state and during continuous intravenous stimulation with 100 ng kg-1h-1 Ceruletide and 1 CU kg-1h-1 secretin. The following groups were studied: 12 normal volunteers (NV), seven patients with chronic pancreatitis with steatorrhea (CPS), and seven without steatorrhea (CP). Stimulated trypsin outputs, after 45 min of stimulation, were the best discriminant among the groups (NV versus CPS, p less than 0.0005; NV versus CP, p less than 0.005; CP versus CPS, p less than 0.05). Basal trypsin outputs showed similar patterns but failed to discriminate between NV and CP. Bicarbonate outputs were less discriminatory than trypsin outputs. Lactoferrin outputs failed to discriminate, but transient high peak outputs occurred in the initial stimulation period in all four patients with calcific chronic pancreatitis, suggesting a washout phenomenon. Basal motilin levels were elevated in both groups of pancreatitis (p less than 0.05). Stimulated pancreatic polypeptide levels were lower in CPS (NV versus CPS, p less than 0.05) but higher in CP (NV versus CP, p less than 0.005). These differences were also apparent in the basal state. We conclude that the best discrimination among the three groups was achieved by measurement of trypsin outputs, after 45 min of stimulation. In addition, the pancreatic polypeptide response may be used as a marker of residual pancreatic function in chronic pancreatitis.

Topics: Adult; Aged; Bicarbonates; Celiac Disease; Ceruletide; Chronic Disease; Female; Humans; Islets of Langerhans; Lactoferrin; Male; Middle Aged; Motilin; Pancreas; Pancreatic Polypeptide; Pancreatitis; Secretin; Trypsin

In adult coeliac sprue patients, intraduodenal instillation of a hypertonic glucose-citric acid solution may release gastrointestinal hormones of the proximal (secretin, gastric inhibitory polypeptide, motilin) and distal (enteroglucagon, neurotensin) small intestine and, indirectly, of the pancreas (glucagon, insulin, pancreatic polypeptide). Characteristic plasma hormone profiles can be measured radioimmunologically. The reduced secretin response reflects most sensitively the impaired function of the small intestine. Exposure of the distal small bowel to greater nutrient loads leads to markedly and constantly elevated plasma levels of enteroglucagon. Only after complete functional as well as morphologic mucosal restoration, the increased enteroglucagon concentrations return to normal. On the other hand, the neurotensin response, which is likewise enhanced in active coeliac sprue, is sooner corrected during treatment. Gastrointestinal hormones with predominantly neurocrine action, such as vasoactive intestinal peptide (VIP), are apparently less affected by coeliac sprue. Pancreatic hormones are involved in the pathophysiology of sprue only indirectly, e. g. via diminished glucose absorption.

Topics: Adult; Blood Glucose; Celiac Disease; Female; Gastric Inhibitory Polypeptide; Gastrins; Gastrointestinal Hormones; Glucagon; Glucagon-Like Peptides; Humans; Insulin; Insulin Secretion; Male; Middle Aged; Motilin; Neurotensin; Pancreatic Polypeptide; Secretin; Vasoactive Intestinal Peptide