Clinical Gastroenterology and Hepatology
Volume 7, Issue 8 , Pages 910-911, August 2009

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published online 29 June 2009.

Article Outline

 

We thank Drs Rashtak and Murray for their comments related to our recently published review article “Persistent nausea and abdominal pain in a patient with delayed gastric emptying.”1 They raise the issue of celiac disease as a cause of the patient's delayed gastric emptying and symptoms. In reviewing our case presentation of a 46-year-old woman with persistent nausea, abdominal pain, and delayed gastric emptying, an upper endoscopy was normal including the duodenum. Neither biopsies nor blood studies for tissue transglutaminase antibodies were obtained. She was treated for idiopathic gastroparesis with improvement of her symptoms.

Rashtak and Murray recommend that duodenal biopsies be obtained in patients undergoing upper endoscopy as part of their work up for refractory dyspepsia. Delayed gastric emptying can be seen in some patients with celiac disease. Delayed gastric emptying has been suggested to explain some of the dyspeptic symptoms in celiac disease.2, 3 In the study by Bassotti et al,4 antroduodenojejunal manometry was performed in 23 patients with celiac disease. Ten had a normal study whereas 2 showed gastric hypomotility. The remaining patients had non-specific abnormalities. Symptoms were not correlated with histologic or manometric findings. A recent study from Turkey suggests that 1.5% of patients with functional dyspepsia may have histologic evidence of celiac disease.5

We have routinely obtained gastric and duodenal biopsy specimens in order to evaluate for microscopic disorders, including eosinophilic, lymphocytic, and collagenous gastritis as well as celiac disease in our patients with possible gastroparesis. This practice started with the reports that celiac disease has been associated with type 1 diabetes mellitus, which can cause gastroparesis. We have found histologic evidence of celiac disease in 2 diabetic patients; the duodenal biopsies have been normal in nondiabetic patients.

Although we believe that a diagnosis of celiac disease is unlikely in our patient with idiopathic gastroparesis, obtaining duodenal biopsies during upper endoscopy is not unreasonable in patients with refractory dyspeptic symptoms.

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References 

  1. Friedenberg FK, Parkman HP. Persistent nausea and abdominal pain in a patient with delayed gastric emptying. Clin Gastroenterol Hepatol. 2008;6:1309–1314
  2. Perri F, Pastore M, Zicolella A, et al. Gastric emptying of solids is delayed in celiac disease and normalizes after gluten withdrawal. Acta Paediatr. 2000;89:921
  3. Hamlyn AN, McKenna K, Douglas AP. Gastric emptying in coeliac disease. BMJ. 1977;1:1257–1258
  4. Bassotti G, Villanacci V, Mazzocchi A, et al. Antroduodenojejunal motor activity in untreated and treated celiac disease patients. J Gastroenterol Hepatol. 2008;23:23–28
  5. Altintaş E, Senli MS, Sezgin O. Prevalence of celiac disease among dyspeptic patients: a community-based case-control study. Turk J Gastroenterol. 2008;19:81–84

 Conflicts of interest The authors disclose no conflicts.

PII: S1542-3565(09)00589-8

doi:10.1016/j.cgh.2009.06.016

Refers to article:

  • Persistent Nausea and Abdominal Pain in a Patient With Delayed Gastric Emptying: Shall We Think of Celiac Disease? , 12 March 2009

    Shadi Rashtak, Joseph A. Murray
    Clinical Gastroenterology and Hepatology August 2009 (Vol. 7, Issue 8, Page 910)

Clinical Gastroenterology and Hepatology
Volume 7, Issue 8 , Pages 910-911, August 2009