Relation between fat malabsorption and transit abnormalities in human carcinoid diarrhea.

OBJECTIVE

Fat and complex carbohydrates in the distal bowel activate "brakes" inhibiting upper gut motility. The hypothesis of this study was that rapid transit carcinoid diarrhea in association with steatorrhea results in impairment of gastric emptying.

METHODS

Fifteen patients with carcinoid diarrhea without prior gastrointestinal resection or whose small bowel resection was limited to < 100 cm of ileum were studied. Gastrointestinal transit was measured scintigraphically with a standardized meal. Percentage of ingested fat excretion was calculated.

RESULTS

Mean length of small bowel resected was 33 cm, and mean 24-hour urine 5-hydroxyindoleacetic acid was 120 mg. Fourteen patients had increased daily stool weights, and 10 had increased stool fat excretion (mean, 13%). Transit was accelerated in the small bowel in 14 and in the colon in all patients. The lag time for gastric emptying was prolonged in 2 patients who had no previous resection. Gastric emptying rate was accelerated in 5, normal in 7, and delayed in 3 patients.

CONCLUSIONS

Ileal and colonic brakes do not seem to delay gastric emptying in patients with carcinoid diarrhea associated with rapid transit and mild to moderate steatorrhea.