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Progress report Thyroid hormones and the gut Thyroid hormones have an effect on the gastrointestinal tract at all levels of organization and clinicians have long recognized the associations that exist between gastrointestinal symptoms and thyroid disease. Our present knowledge of the mechanisms by which thyroid hormones act on the gut is, however, fragmentary and much of the literature which deals with disturbances in gastrointestinal physiology in hyper-and hypothyroidism is inconclusive." 2 This review is brief and makes no attempt to be comprehensive. It is intended to illustrate some aspects of the effects of altered thyroid function on the gastrointestinal tract rather than to dwell on the biochemical role of thyroid hormones at the cellular and subcellular level-a subject recently reviewed elsewhere.3 Patients with hyperthyroidism or hypothyroidism and symptoms referable to the alimentary tract rarely regard these symptoms as major complaints. This may explain the paucity of studies relating gastrointestinal disturbances to thyroid disease. Changes in appetite, however, are commonly noted by patients, and whereas hyperthyroid patients tend to develop hyperphagia, hypothyroid patients more frequently decrease their food intake. Apart from these changes in diet the commonest gut-related complaints reported in thyroid diseases are undoubtedly those due to disordered bowel functionin particular alteration in bowel habit. The Stomach in Thyroid Diseases Neither hyperthyroidism nor hypothyroidism is associated with consistent gross pathological changes in the stomach. Studies from many centres confirm, however, that alterations in gastric structure and function may accompany thyroid disease. The level of gastric acid secretion has been reported to vary greatly with both hyperand hypothyroid states, depending to some extent upon the experimental animal studied. In man, hyperthyroidism is frequently associated with histological gastritis and with diminished acid output4'5 which may amount to achlorhydria. These abnormalities tend to return towards normal as the hyperthyroidism is controlled.5'6 In the individual patient the correlation between histological changes in the stomach and alterations in hydrochloric acid secretion is far from absolute and the mechanism by which hydrochloric acid secretion is reduced in thyrotoxicosis is not clear.5 In spite of the normal or low gastric acid production in thyrotoxicosis at least one study7 has reported an increased incidence of duodenal ulceration. This association was not confirmed, however, in a review of 9,618 patients with hyperthyroidism.8 The rate at which the stomach empties its contents into the duodenum depends to some extent upon the level of circulating thyroid hormone. This important factor must be considered when assessing intestinal absorption following oral administration of test substances, eg, a glucose tolerance test. The stomach empties rapidly in hyperthyroidism, 9,10,1112 whilst in hypothyroidism gastric emptying is prolonged." These alterations in ga...

The occurrence of acute pancreatitis in gastric aberrant pancreas is described. The patient presented initially with acute abdominal pain and a palpable epigastric mass. The symptoms were severe and recurrent, and laparotomy with antrectomy was required.

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