Orocaecal transit time in health and in thyroid disease.

Abstract

SUMMARY Altered bowel habit commonly occurs in thyroid disease. We measured orocaecal transit in healthy volunteers and in hyperthyroid and hypothyroid patients before and after treatment, using the lactulose hydrogen breath test incorporating a standard liquid meal to obtain a more physiological assessment. Mean transit time in 12 control subjects was 85 (8) minutes (mean (SE)) (mean coefficient of variation between replicate studies, 8-6% (3%)). In eighteen hyperthyroid patients transit was more rapid at 49 (4) minutes (p<0-01). Ten hypothyroid patients had a transit time similar to controls at 91 (9) minutes. Transit time returned to normal in thyrotoxic patients after treatment but in eight hypothyroid patients retested, it remained unchanged. Our findings suggest that (a) the inclusion of a liquid meal provides a reproducible method of measuring orocaecal transit using the lactulose hydrogen breath test, (b) rapid small bowel transit in thyrotoxicosis may be one factor in the diarrhoea which is a feature of the disease and (c) if altered gut transit is the cause of sluggish bowel habit in hypothyroidism, delay in the colon, and not small bowel, is likely to be responsible.

Gastroparesis: pathogenesis, diagnosis and management

“…65 Hypothyroidism, hyperparathyroidism, cirrhosis, chronic renal failure, chronic pancreatitis and cystic fibrosis are also associated with gastroparesis. [66][67][68] Patients with criti cal illness in the intensive care unit may exhibit delayed gastric emptying and this can influence feeding decisions.…”

Pharmacokinetic Considerations in Gastrointestinal Motor Disorders

“…Diseases causing abnormal gastrointestinal motor activity may have systemic manifestations or be confined to the gastrointestinal tract. For example, hyperthyroidism is associated with rapid intestinal transit which normalises with treatment, [68][69][70] and in hypothyroidism, transit is slower than norma1. 171 ] In addition to potential abnormalities in the pharmacokinetics of orally administered drugs, the clinical manifestations of abnormal gastrointestinal motility include gastrointestinal symptoms, nutritional deficiencies and poor blood glucose control in diabetic patients.…”

Approach to the Patient with Diarrhea

“…Similar abnormalities of the migrating motor complex have been reported in patients with the painless diarrhea variant of IBS, and a rapid orocecal transit time has been demonstrated [293,294]. Carbohydrate wastage from rapid transit may be part of the pathophysiology of diarrhea in thyrotoxicosis [295] and ulcerative colitis [296]. Carbohydrate is metabolized to H 2 and CO 2 by colonic bacteria, which means that symptoms of excess flatus, abdominal bloating, and cramping abdominal pain may be important clues to the diagnosis of carbohydrate malabsorption.…”