[Thyroid-intestinal motility interactions summary]

Thyroid diseases may be related to gastrointestinal motility symptoms. Such symptoms can vary in degree and, sometimes, are the only clue of a thyroid disease or, at least, the first. The mechanism by which the thyroid hormones can influence gastrointestinal motility, even if not still completely elucidated, can be found in a synergism between a direct effect of the thyronins and an indirect effect mediated by cathecolamines on the muscle cell receptors. Neck discomfort and dysphagia are common findings in patients with thyroid diseases. Hyper- and hypothyroidism can impair esophageal motility, modifying pharyngo-esophageal structure and/or muscular function and interacting with the neuro-humoral regulation of the esophageal peristalsis. Oesophageal motility alterations, observed in patients affected by small non-toxic goiter, are less understandable. At the gastro-duodenal level, basic and postprandial electric rhythm alterations have been observed in hyperthyroid patients, often associated with delayed gastric emptying, too. In such patients, the autonomous nervous system dysfunction may even modify the neuro-hormonal mutual regulation (vagal influence decrease) of the gastro-duodenal myoelectric activity. Hypothyroidism may cause a delay of the gastric emptying too, but such pattern may also be related to an associated autoimmune disease or to an independent chronic modification of the gastric mucosa. Diarrhoea and malabsorption are common findings together with hyperthyroidism, whereas constipation is frequently observed in hypothyroidism. The clinically most demanding situation is certainly the secondary chronic intestinal pseudo-obstruction syndrome, which involves the bowel in most cases, but may also show up by means of a mega-small bowel or a mega-duodenum, or even all of the above. In conclusion it may be stated that: 1) thyroid diseases may be related to symptoms due to digestive motility dysfunction. 2) Any segment of the gastrointestinal trait may be involved. 3) The typical clinical manifestations of the thyroid illnesses may be borderline, missing or concealed by other intercurrent illnesses, especially in the elderly patients. 4) Motility-related digestive symptoms may conceal an underlying, easily misdetected, thyroid disease and must be therefore carefully analyzed.

[Effects of intravenous administration of clarithromycin on plasma levels of gastrin and group I pepsinogen]

Erythromycin and some of its derivatives have prokinetic gastrointestinal properties. In addition, erythromycin has been shown to stimulate isolated chief cells of the gastric mucosa, and to activate pepsin secretion. The above study was aimed at ascertaining in a group of dyspeptic patients whether clarithromycin, a structural analogue of erythromycin, is apt to modify certain functional parameters of gastric secretion, above all the patterns of gastrin and PG-I secretion. A 20-minute intravenous clarithromycin infusion (1.5 mg/kg) in fasting subjects has brought about a significant reduction (at 20 and 45 minutes from the start of infusion) of circulating gastrin (about 23%) and, after a meal, a 69% increase. No change of plasma PG-I level was observed either after placebo or after the active substance. These findings suggest that in vivo and at the doses used in our experiment clarithromycin has no influence on plasma PG-I release and is apt to modify the fasting and postprandial gastrin releasing pattern.

[Psycho-emotional distress and gastroesophageal reflux syndrome]

61 patients with symptoms suggestive for gastro-esophageal reflux (GER) disease, with or without endoscopic evidence of esophagitis, were studied in order to recognize any neurotic traits connected to GERD and its esophageal motility disorders. The results were compared with those from a group of patients without digestive diseases as well as those from a control group of the same age and status. Psychological assessment was made by using the Middlesex Hospital Questionnaire and esophageal motility pattern was analyzed with a low-compliance manometric system. Patients with gastro-esophageal reflux (GER), irrespectively or not from esophagitis, showed, after such a psychological assessment, neurotic traits more pronounced than control subjects and patients without digestive disease. In GER patients, it was observed a close relationship between some psychological traits and a few esophageal manometric variable. In the two groups of GER patients, with and without esophagitis, it was not found any significant difference in scores referring to the evaluated psychological traits apart from symptoms somatization, prevailing in GER patients without esophagitis. These results support the pathogenetic role of psychological distresses in the genesis of GER, even if other factors may be necessary to the development of organic inflammatory lesions such as esophagitis.

[Changes in mechanical and functional processes of the lower esophageal sphincter in patients with reflux esophagitis]

The present study was performed to establish eventual inferences of functional and mechanical alterations of the lower esophageal sphincter (LES) in determining reflux esophagitis. The LES basal pressure, the percentual incidence of the incoordinate LES relaxations swallowing-induced, the LES overall and abdominal length, with gastroesophageal reflux disease (GERD), with and without endoscopic evidence of esophagitis, were manometrically evaluated in 117 consecutive patients. In patients with symptomatic GERD, a significant LES pressure reduction, which is inversely related to the severity of the endoscopic mucosal damage, an increased prevalence of the incoordinate LES relaxations swallowing-induced and, only in patients with esophagitis, a significant reduction of the LES overall and abdominal length of the LES, were showed. Two or three alterations of the LES antireflux devices can occur in the same patient, thus increasing the risk of esophagitis.