Gastrointestinal motility disorder in celiac disease: influence of osteopathic correction

Introduction . Celiac disease is an immune-mediated disease caused by gluten consumption in genetically predisposed individuals. The main site of damage in celiac disease is the duodenum, where atrophic changes in the villous portion of the mucosa develop. Mucosal damage and inflammation can affect intestinal contractile motility through disruption of complex hormonal and neuro-immune regulation. It is known that osteopathic correction can influence the motor and evacuatory activity of the gastrointestinal tract. The aim of the study : to evaluate the results of osteopathic treatment on stomach and duodenal motility in patients with celiac disease. Materials and methods . In accordance with the inclusion criteria, 131 patients with diagnosed celiac disease associated with gallbladder dysfunction who received medical care in the gastroenterology department and at the clinical base of the Department of Osteopathy I. I. Mechnikov North-Western State Medical University (LLC «Mokhov Institute of Osteopathy») from 2016 to 2022 were included in the study. All subjects were distributed into 3 groups by the method of simple randomization. The main group included patients who received combined therapy (osteopathic correction and ursodeoxycholic acid preparations) — 50 people. Ursodeoxycholic acid preparations were used for treatment of gallbladder dysfunction. The control group consisted of patients who received only ursodeoxycholic acid preparations — 35 people. The comparison group included patients who received only osteopathic correction — 46 people. Osteopathic examination was performed according to the approved clinical recommendations. Osteopathic correction of the identified somatic dysfunctions was carried out to the patients of the main group and the comparison group once every 10 days for 3 months, the average course of osteopathic treatment amounted to 6 sessions. Peripheral electrogastroenterography was performed using a gastroenteromonitor device GEM-01 «Gastroscan-GEM» (NPP «Istok-System», Fryazino), by means of which electrical potentials of the gastrointestinal tract sections were recorded from the skin surface of the subject. Analysis of the frequency spectrum of electrical waves reflecting the electrical activity of smooth muscle cells made it possible to judge about the motor activity and motor-evacuatory function of these gastrointestinal tract sections. Results. Based on the obtained parameters of myoelectric activity evaluated by tone (Pi/Ps), rhythmicity (Kritm) and propulsivity (Pi/Pi+1stomach/duodenum), functional features were determined in patients with celiac disease, which were confirmed by a decrease in relative electrical power and rhythmicity coefficient, indicating anthroduodenal dyscoordination during food stimulation. Integral changes in myoelectric activity tone, rhythmicity and propulsivity indicated impaired postprandial motility of the stomach and duodenum, which was confi rmed by corresponding changes in the values of bioelectric activity indices after food stimulation. After the therapy (3 months after the beginning of the study) the overwhelming majority of patients of the main group and the comparison group had a normal variant of myoelectric activity response of the stomach (80 and 76,1 %, respectively) and duodenum (58 and 65,2 % respectively). Conclusion . The use of osteopathic correction improves the functioning of the stomach and duodenum compared to drug treatment, affecting the coordinated functioning of the gastroduodenal area. The use of osteopathic correction contributes to the optimization of gastroduodenal motility.