Comparison of anorectal manometry and visceral sensitivity before and after gluten free diet in celiac disease

Abstract

Celiac disease is one of the most common genetic diseases, the only treatment for which is a gluten-free diet, so a complete gluten-free diet is very important in these people. In this study, the effect of treating celiac patients with full observance of gluten-free diet was followed by rectal manometry. Materials and methods: In this study, after obtaining patient consent, obtaining the consent of the ethics committee of Tabriz University of Medical Sciences, patients over 18 years of age with celiac disease were included in the study. % And 95% confidence interval and 30% probability of loss were considered 37 people. In this study, about 37 known celiac patients over 18 years of age and under 51 years of age were newly diagnosed untreated or incompletely treated who did not have anorectal anatomical problems (Fisher, hemorrhoids, stenosis, surgical scar) and no history of multiparipathy. Will enter the study and will measure anorectal manometric parameters once before treatment and when it is positive during routine anti-TTG celiac disease and once after at least two months of full gluten-free diet which becomes negative during anti-TTG follow-up in these patients. All patients with anorectal symptoms questionnaire before and after treatment with a score of 0 to +10 for each type of complaint will be completed and again this questionnaire will be asked before performing control manometry in patients treated with gluten-free diet and this Signal matching with changes in flat manometric data will be examined. Results: After the gluten-free diet, the maximum resting pressure increased significantly and was within the normal range (P <0.001). For other variables, maximal squeeze pressure and first sensation threshold, as well as desire to defecate threshold and rectal pain discomfort threshold were low in most people, which increased after gluten-free diet, but no significant difference was observed between the values (P> 0.05) In the case of maximal cough pressure and volume initiating the internal anal sphincter relaxation (recto-anal inhibitory reflex -RAIR) both before and after the diet was in the normal range and there was no difference. Anorectal symptoms included a total of 27 patients (72.97%) with abdominal pain, 24 patients (64.86%) with diarrhea, 8 patients (21.62%) with constipation and 30 patients (81.08%) with bloating. The abdomen showed that after two months of a gluten-free diet all the patient's symptoms improved. Only in one of the patients with constipation did the symptoms remain.