Introduction

Coeliac disease (CD) is a chronic, multi-organ, immune-mediated disease associated with gluten intake in genetically susceptible individuals. There is an emerging trend in raising prevalence, which is generally accepted to be about 1% in the world population. To date, there is not generally used and universal noninvasive indicator of activity and functional integrity of the small intestine in patients with CD. Citrulline, a non-essential amino acid produced almost exclusively in enterocytes, is already known to be a reliable marker
of small intestinal function in individuals with severe impaired small intestinal function (e.g. complicated forms of CD with malabsorption syndrome and/or short bowel syndrome). The data about the ornithine (citrulline’s intermediate) serum concentrations in CD patients are limited so far.

Aims & Methods

The aim of our study was to investigate if serum concentrations of citrulline and/or ornithine differed among patients with CD compared with healthy controls and could be used as a disease activity indicators in uncomplicated disease. We examined serum citrulline and ornithine levels in a subgroup of patients with proven coeliac disease and
healthy controls. A total of 94 patients with CD (29 men, mean age 53 ± 18 years; 65 women, mean age 44 ± 14 years) and 35 healthy controls with serologically excluded CD (10 men, mean age 51 ± 14 years; 25 women, mean age 46 ± 12 years) were included in the study. The basic clinical and laboratory data (age, weight, disease duration, BMI, body surface area, haemoglobin, leukocytes, MCV) including the serological profile of the CD (anti-tissue transglutaminase IgA in the subgroup of patients together with anti-tissue
transglutaminase IgG, anti-endomysial IgA and IgG, anti-deamidated gliadin peptide IgA and IgG and anti-reticulin IgA and IgG in the subgroup of healthy controls) were collected.

Results

Significantly lower concentrations of serum ornithine were found in patients with CD (mean 65 ± 3 μmol/L; median 63 μmol/L, IQR 34 μmol/L, p < 0.001). No statistically nor clinically significant differences were found in the citrulline concentrations between the study and control group. We proved statistically significant stronger correlation between plasma citrulline and ornithine levels in the group of patients with CD versus the group of healthy controls where the correlation was weak (Spearman's coefficient 0.723 vs. 0.313). For other quantitative features no significant correlation was found in the group of patients with coeliac disease and healthy controls.

Conclusion

Serum ornithine (but not citrulline) may be useful for assessing the functional status of the small intestine in uncomplicated coeliac disease. Further studies involving more detailed analysis of dietary and metabolic changes in coeliac patients will be needed to reach definitive conclusions.

Introduction

Diabetes is one of the most common metabolic diseases worldwide with rapidly growing of incidence. While the recent Rome Global Epidemiology Study revealed significant insight into the epidemiology of disorders of gut-brain interaction (DGBI) in the general population at a large-scale multi-national level, the prevalence of DGBI in diabetic population remains to be characterized in detail. Gastrointestinal symptoms are commonly presented in patients with diabetes because of diabetic neuropathy, chronic inflammation, and disrupted gut microbiota.

Aims & Methods

Aim: To assess the prevalence of the DGBI among subjects with type 1 and type 2 diabetes in the community setting.
Methods: We conducted a prospective survey of diabetic subjects by distributing online questionnaires via the Diabetes League (independent diabetic patient support and information organization in Belgium) and via general practitioners. Participants filled out an online survey. The survey contained the Adult Rome IV Diagnostic Questionnaire, PHQ-15, PROMIS Global-10, Visceral Sensitivity Index, GAD-7, PAGI-SYM, PAGI-QOL, Waiting Room Questionnaire and SF-NDI. Using the Rome Diagnostic Questionnaire, we selected patients who fulfilled the diagnosis criteria of DGBI, including chronic nausea vomiting syndrome (CNVS), cyclic vomiting syndrome (CVS), rumination syndrome, functional dysphagia, functional dyspepsia (FD) and irritable bowel syndrome (IBS). Patients who self-reported a relevant organic gastrointestinal disease, were taking Glucagon-like peptide-1 agonists or had a history of extensive abdominal surgery were excluded. Prevalences are reported as percentages with 95% Confidence Intervals. To compare two groups, Pearson’s chi-squared tests (Fishers exact test if any one cell of 2x2 table <5) and 2 sample T-tests were used.

Results

210 diabetic patients (72.4% type 1 diabetes, 62.4% female, mean age 44.6±15.6 years, BMI 26.0±4.5 kg/m², 126 recruited through the diabetes association) were included. 41.0% of diabetic subjects had self-reported gastrointestinal symptoms. The prevalence of CNVS, CVS, rumination syndrome, functional dysphagia, FD and IBS was 1.4% (95% CI: 0.3-4.1), 0.5% (95% CI:0.0-2.6), 4.3% (95% CI:2.0-8.0), 2.4% (95% CI: 0.8-5.5), 7.6% (including 5.7% postprandial distress syndrome (PDS), 1.4% epigastric pain syndrome (EPS) and 0.5% overlap; 95% CI: 4.4-12.1) and 6.7% (95% CI: 3.7-10.9), respectively. Comparing type 1 and type 2 diabetes, the patients with type 2 diabetes had significantly older age and higher BMI (both p<0.001). There was no significant difference in the prevalence of DGBI between the two groups (Table 1). In type 1 diabetes, IBS (7.2%) was the most frequently observed among DGBI, while those with type 2 diabetes were more commonly affected by FD (12.2%), but no statistical significance was obtained at the current sample size.

Table 1 Participants’ characteristics and prevalence of DGBI in Type 1 and Type 2 diabetes (% and 95% CI)

Conclusion

DGBI are prevalent among people with type 1 or type 2 diabetes in the community setting. Increasing awareness of DGBI and providing specific treatment options in this population might improve patient outcomes.

References

Sperber, Ami D. et al. "Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation Global Study." Gastroenterology 160.1 (2021): 99-114.

Disclosure

I have no conflict of interests