The effects of loperamide in patients with IBS (all had diarrhoea as a main symptom) were studied in a double-blind placebo controlled trial. Subjective overall response, stool consistency and six individual symptoms (urgency, pain, frequency, flatulence, borborygmi and painful propulsions) were studied over a 13 week long treatment period. Twenty-one patients out of 25 completed the trial, 11 in the loperamide group and 10 in the placebo group. A significant advantage for loperamide was found for stool consistency (p
Intestinal disease might contribute to osteopenia. Measurements of IgA antibodies to gliadin have been established as an accepted screening procedure for detection of coeliac disease. When we applied these measurements to 92 patients with verified osteoporosis, 11 subjects (12%) were found to have elevated levels. This is markedly higher than the incidence in healthy subjects (3%). However, the patients with raised levels of IgA antibodies displayed no clinical symptoms and no laboratory evidence of calcium malabsorption. Thus their values for serum calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase and osteocalcin, as well as the fasting urinary excretion of hydroxyproline and calcium, were similar to those found in other patients with osteoporosis. Intestinal biopsy verified coeliac disease in three patients and was normal in another three. This gives an incidence of verified coeliac disease in this patient group that is approximately tenfold higher than that in the healthy population. Subclinical coeliac disease appears to be unusually over-represented among patients with idiopathic osteoporosis, and screening for gliadin antibodies might therefore be a valuable addition to the routine assessment of the osteopenic patient. The mechanisms underlying the relationship are not clear, but calcium malabsorption is not evident.
Intestinal secretion rates of albumin, hyaluronan, and beta2-microglobulin (beta2-micro) were determined under basal conditions and after gliadin challenge of coeliac patients and healthy controls by the use of a jejunal perfusion technique. A new tube system was used where a jejunal segment is isolated between balloons and then perfused with a balanced salt solution. Under basal conditions the secretion rate of albumin was similar in the patients and controls while the secretion rate of the glycosaminoglycan hyaluronan, a high molecular weight connective tissue component, was increased more than two times in coeliac patients. Beta2-micro was secreted in on average three-fold rates in coeliacs compared with controls. All three substances were secreted at a higher rate in patients with active disease than in those with inactive disease defined by morphological damage in small bowel biopsies. The concentrations in jejunal perfusion fluids relative to serum levels in the coeliac patients were for albumin 0.0007, beta2-micro 0-10, and for hyaluronan 1-94. Challenge with a single dose of gliadin into the jejunal segment gave within 60 min a significant, about two-fold, increase of the secretion rates of all three measured substances. The appearance of hyaluronan could reflect a gliadin induced mucosal oedema with an enhanced leakage from the interstitial/lymph fluid, rich in this glycosaminoglycan. The observed parallel increases in the jejunal secretion of albumin and beta2-micro after gliadin challenge are best explained by a similar mechanism.
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