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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.

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BACKGROUND: Twenty-three cholecystectomized patients, asymptomatic or with recurrent biliary pain, were studied. METHODS: Six patients were asymptomatic without organic complications of the biliary tree and negative cholestasis laboratory tests; six were symptomatic with gallstones or stenosis of the main biliary tree; eleven patients were symptomatic without organic diseases. All the groups of patients were matched for age and sex. The filling and emptying kinetics of the biliary tree were studied by sequential cholescintigraphy with trimetil-Br-IDA 99mTc and computized gamma-camera. The exam was performed for sixty minutes during fast and for sixty minutes after a standard cholecystokinetic meal. RESULTS: Hepatic clearance time of the compound, filling and emptying of the biliary tree were significantly longer in patients with organic obstruction than in the other groups. The differences between controls and patients with anorganic diseases were otherwise not significative. IN CONCLUSION: 1) in cholecystectomized patients the recurrent biliary pain is likely present independently of alterations of the biliary wash-out; 2) sequential cholescintigraphy is a very good method, as well as endoscopic procedures, to identify organic obstruction of the main biliary tree. However, it is not sufficiently sensitive to demonstrate functional alterations of the biliary tract.

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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.

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Low-compliance standard manometry and 24-hour ambulatory pH monitoring were performed in 42 patients with typical gastro-esophageal reflux (GER) symptoms in order to assess correlations between esophageal motility pattern and pH profile. Our results show: 1) 36% of GER patients had a normal esophageal acid exposure; 2) pH profile and manometric pattern did not differ in patients with mild esophagitis from those without esophagitis; 3) low esophageal sphincter pressure in GER patients was significantly lower than in control subjects, irrespective of acid exposure; 4) the main motility disorders in the distal esophagus of reflux patients was the increased simultaneous wave rate which seemed to affect both recumbent esophageal clearance and reflux time.

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Two monozygotic female twins with chronic idiopathic intestinal pseudo-obstruction associated with transverse colon volvulus are described. Quite similar clinical events and temporal coincidences characterized the symptoms which has preceded and followed right colectomy undergone by both of them due to intestinal volvulus. The esophageal, gastroduodenal, colonic and anorectal manometric investigation revealed very similar alterations in both girls. Increased amplitude of distal contractions of the esophagus, a depressed fasting antro-duodenal motility, with absence into antrum and oro-aboral non-propagation in the duodenum of the phase III activity of the interdigestive motor complex were the main findings along with a state of pronounced colonic hypomotility and an hypoesthesia of the rectal ampulla to the volumetric stimulus. This report indicates the association between chronic intestinal pseudo-obstruction and transverse colon volvulus in monozygotic female twins, and it points out the rarity both of the specific symptomatic coincidences and the similar clinical events and of the almost absolute identity of the intestinal motor patterns.

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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.

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