Increased fasting small-bowel water content in untreated coeliac disease and scleroderma as assessed by magnetic resonance imaging

Lam, Ching; Sanders, David; Lanyon, Peter; Garsed, Klara; Foley, Stephen; Pritchard, Susan; Marciani, Luca; Hoad, Caroline L.; Costigan, Carolyn; Gowland, Penny; Spiller, Robin

Abstract

Background and aims: The regular overnight migrating motor complex (MMC) ensures that the normal fasting small bowel water content (SBWC) is minimised. We have applied our recently validated non-invasive magnetic resonance technique to assess SBWC in newly diagnosed coeliac disease (CD), scleroderma (SCD) and irritable bowel syndrome (IBS) conditions, possibly associated with small intestinal bacterial overgrowth (SIBO).

Methods: 20 CD and 15 SCD patients with gastrointestinal symptoms were compared to 20 healthy volunteers (HV) and 26 IBS with diarrhoea (IBS-D) patients as previously reported. All underwent a fasting, magnetic resonance imaging (MRI) scan on a 1.5 T Philips Achieva MRI scanner to assess fasting SBWC and colonic volumes. Stool and symptom diaries were completed for 1 week.

Results: Median (Interquartile range, IQR)
Compared to healthy volunteers, all the patients had significantly increased stool frequency and Bristol stool form score. SBWC was significantly increased in CD 109(53-224) vs. 53(31-98) mL in HV, p [less than] 0.01 and 42 (28-67) in IBS-D, p [less than] 0.01. Variable increase in SBWC was also found in SCD, median 77(39-158) but this was not significant, p=0.2. Colonic volumes were similar for all groups being 547 (442-786) for CD, 511 (453-789) for SCD, 612 (445-746) for HV and 521 (428-757) mL for IBS-D. When CD patients were subdivided according to the Marsh classification, the higher grades had larger colonic volumes.

Conclusion: Fasting SBWC as assessed by MRI is significantly increased in newly diagnosed CD and SCD but decreased in IBS-D. Future studies should test whether increased resting fluid predisposes to SIBO.

Citation

Lam, C., Sanders, D., Lanyon, P., Garsed, K., Foley, S., Pritchard, S., Marciani, L., Hoad, C. L., Costigan, C., Gowland, P., & Spiller, R. (2019). Increased fasting small-bowel water content in untreated coeliac disease and scleroderma as assessed by magnetic resonance imaging. United European Gastroenterology Journal, 7(10), 1353-1360. https://doi.org/10.1177/2050640619860372

• Journal Article Type: Article
• Acceptance Date: May 28, 2019
• Online Publication Date: Jun 21, 2019
• Publication Date: Dec 1, 2019
• Deposit Date: Jun 14, 2019
• Publicly Available Date: Jun 17, 2019
• Journal: United European Gastroenterology Journal
• Print ISSN: 2050-6406
• Electronic ISSN: 2050-6414
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 7
• Issue: 10
• Pages: 1353-1360
• DOI: https://doi.org/10.1177/2050640619860372
• Keywords: Small bowel; Magnetic resonance imaging; Irritable bowel syndrome; Coeliac disease; Scleroderma
• Public URL: https://nottingham-repository.worktribe.com/output/2188020
• Publisher URL: https://journals.sagepub.com/doi/full/10.1177/2050640619860372
• Additional Information: Lam, C., Sanders, D. S., Lanyon, P., Garsed, K., Foley, S., Pritchard, S., … Spiller, R. (2019). Increased fasting small-bowel water content in untreated coeliac disease and scleroderma as assessed by magnetic resonance imaging. United European Gastroenterology Journal. https://doi.org/10.1177/2050640619860372
• Contract Date: Jun 17, 2019