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Indirect evidence for increased mechanosensitivity of jejunal secretomotor neurones in patients with idiopathic bile acid malabsorption
Author(s) -
Bajor A.,
Ung K.A.,
Öhman L.,
Simren M.,
Thomas E. A.,
Bornstein J. C.,
Sjövall H.
Publication year - 2009
Publication title -
acta physiologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.591
H-Index - 116
eISSN - 1748-1716
pISSN - 1748-1708
DOI - 10.1111/j.1748-1716.2009.01993.x
Subject(s) - medicine , jejunum , endocrinology , malabsorption , gastroenterology , bile acid , migrating motor complex , chemistry , stomach
Aim: The interdigestive motor rhythm, the migrating motor complex (MMC), is accompanied by active secretion of chloride during periods of distally propagating maximal motor activity (MMC phase III). We studied the behaviour of this system in bile acid malabsorption (BAM), a relative common cause of chronic diarrhoea. We measured motor activity and transmucosal potential difference (PD, reflecting active chloride secretion), in the proximal jejunum in healthy controls ( n = 18) and in a group of patients with BAM ( n = 11). The phase III‐generated voltage was related to the degree of BAM quantified by the 75 SeHCAT test. Methods: We used a multi‐channel intestinal infusion system to simultaneously measure jejunal pressure and PD. Saline passing calomel half‐cells was infused into the jejunum and subcutaneously. Pressure and PD were recorded in the fasting state and after a test meal. Results: In the absence of motor activity, jejunal PD was not significantly different from zero in either group. During MMC phase III, PD reached significantly higher mean and peak levels in BAM patients. The product of MMC phase III length multiplied by voltage, over 3 h, was also significantly higher in BAM patients (controls: median 307 mV × cm, range 70–398; BAM: median 511, range 274–2271, P < 0.01). This value was also significantly correlated with the degree of BAM as reflected by the 75 SeHCAT test ( P < 0.05). Conclusion: Phase III induced jejunal secretion may be upregulated in BAM patients, resulting in overload of colonic reabsorption capacity.