Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Jun 9, 2020; 11(2): 17-24
Published online Jun 9, 2020. doi: 10.4292/wjgpt.v11.i2.17
Gastrointestinal symptoms in acromegaly: A case control study
Nashiz Inayet, Jamal Hayat, Gul Bano, Andrew Poullis
Nashiz Inayet, Jamal Hayat, Andrew Poullis, Department of Gastroenterology, St Georges Hospital and St Georges, University of London, London SW17 0QT, United Kingdom
Gul Bano, Department of Endocrinology, St Georges Hospital and St Georges, University of London, London SW17 0QT, United Kingdom
Author contributions: Poullis A and Hayat J designed the project and reviewed the statistics and the manuscript; Bano G identified the cases and reviewed the manuscript; Inayet N collected the data, carried out the statistical analysis and wrote the manuscript.
Institutional review board statement: The study protocol was approved by the South West-Central Bristol Research Ethics Committee and NHS Health Research Authority United Kingdom.
Informed consent statement: All patients had given informed consent for this study.
Conflict-of-interest statement: The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article.
Data sharing statement: The questionnaire data used to support the findings of this study are available from the corresponding author upon request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Nashiz Inayet, BSc, CCST, MBBS, MD, MRCP, Doctor, Senior Lecturer, Department of Gastroenterology, St Georges Hospital and St Georges, University of London, Blackshaw Road, Tooting, London SW17 0QT, United Kingdom. n.inayet@nhs.net
Received: December 31, 2019
Peer-review started: December 31, 2019
First decision: January 19, 2020
Revised: April 25, 2020
Accepted: May 29, 2020
Article in press: May 29, 2020
Published online: June 9, 2020
Processing time: 159 Days and 11.2 Hours
Abstract
BACKGROUND

Acromegaly is a chronic disease caused by a pituitary somatotroph adenoma resulting in excess secretion of growth hormone, which leads to excess secretion of Insulin like growth factor 1 from the liver, causing abnormal soft tissue growth. There is increasing awareness that diseases affecting connective tissue are associated with an increase in functional gastrointestinal symptoms. Data was collected from patients with a confirmed diagnosis of acromegaly to evaluate the intensity, variety and impact of abdominal symptoms in comparison with a control group who were healthy participants recruited from the local fracture clinic.

AIM

To evaluate the frequency type and burden of abdominal symptoms in acromegaly in comparison with a control group.

METHODS

Medical documentation of patients with a diagnosis of acromegaly treated in one tertiary medical centre between 2010 and 2017 has been analysed. Data was collected from patients with confirmed acromegaly, using the Short Form Health Survey (SF36) and Rome IV Diagnostic questionnaire for Functional Gastrointestinal Disorders in Adults (R4DQ) and compared to a sex- and age-matched control group, to assess the burden of abdominal symptoms. Microsoft Excel and IBM SPSS v 25 were used for data analysis.

RESULTS

Fifty patients with acromegaly (24 male and 26 females; age range 23-64 years, mean 43) and 200 controls (96 male and 104 females; age range 18-84, mean 42.4) were recruited. 92% (46 out of 50) of patients with acromegaly reported abdominal symptoms and 78% (39 out of 50) had at least one functional gastrointestinal disorder according to the Rome IV diagnostic criteria, compared to 16% of controls (OR > 1, P < 0.0001). The most commonly reported symptom was constipation (69% acromegaly vs 21% of controls OR > 1, P < 0.0001, 95%CI: 4.4–15.8). 34 out of 50 (68%) respondents met the criteria for functional constipation according to Rome IV. Upper gastrointestinal disorders were also more prevalent in the acromegaly group. There was no statistically significant difference in the prevalence of biliary and anorectal symptoms between the two groups. Patients in acromegaly group scored lower on the mean scores of the eight parameters of SF36 Quality of Life questionnaire (mean scores 60.04 vs 71.23, 95%CI: -13.6829 to -8.6971, OR > 1, P < 0.001) as compared to the control group.

CONCLUSION

Upper and lower functional gastrointestinal tract disorders (defined by Rome IV diagnostic criteria) are significantly more prevalent in patients with acromegaly compared with healthy age and sex matched controls in our study. Functional constipation is the most commonly reported problem. Poorer quality of life may in part be attributable to the increased prevalence of abdominal symptoms.

Keywords: Functional gastrointestinal disorders; Acromegaly; Constipation; Irritable bowel syndrome; Somatostatin; Pituitary

Core tip: Irritable bowel syndrome is the commonest cause of gastrointestinal symptoms. The aetiology is thought to be multi-factorial but remains incompletely understood. Our group has previously identified that patients with connective tissue disorders have an increased incidence of functional gastrointestinal symptoms. Investigating for these symptoms in patients with acromegaly may give further insight into the pathogenesis of functional disorders and irritable bowel syndrome.