There was no statistically significant difference of prevalence of biliary and anorectal symptoms between the acromegaly group and controls (Table (Table3 3).Īcromegaly is a rare and unique disease associated with abnormal soft tissue growth with a prevalence that is estimated at 40 per million in United Kingdom and an annual incidence rate ranging between 2 and 11 cases per million per year, with an equal distribution between genders.Īcromegaly is associated with gastrointestinal complications, such as constipation, higher prevalence of colorectal polyps and cancer and higher prevalence of gallstones in patients treated with Somatostatin analogues. Some oesophageal and gastroduodenal conditions such as functional heartburn, functional dysphagia and functional dyspepsia also showed statistically significant prevalence in acromegaly group. All bowel symptoms showed statistically significant prevalence in the acromegaly group. The prevalence of constipation increased with increasing age and was often associated with bloating. Thirty-four out of 50 (68%) respondents met the criteria for functional constipation according to Rome IV. We assessed the frequency, character, severity and burden of abdominal symptoms in patients with acromegaly in comparison with a control group.ī P 1, P 1, P < 0.0001, 95%CI: 2.5-9.3). Our aim was to evaluate gastro-intestinal symptoms in a cohort of acromegaly patients. Due to the higher risk of colon cancer, acromegaly patients are offered screening colonoscopy during which standard preparation for colonoscopy is often found inadequate, indicating functional and structural change. Somatostatin analogues used in the treatment of acromegaly are also associated with a wide range of abdominal symptoms. The impact of soft tissue changes associated with over secretion of GH and gastrointestinal symptoms has not previously been studied. We have previously identified how changes in connective tissue in hypermobility (in Marfan and Ehlers Danlos) are associated with an increase in functional gastrointestinal symptoms. The organic gastrointestinal pathology associated with acromegaly such as increased risk of colonic cancer and an increased risk of cholelithiasis has been studied in detail, however the issue of overall burden of gastrointestinal symptoms, particularly the functional disorders in acromegaly and the gastrointestinal effects of its treatment have not been well studied. In addition to the insulin-like effects, IGF-1 can also regulate cellular DNA synthesis and is an important signalling molecule with regards to cancer cell transformation and proliferation, including mitogenesis and apoptosis inhibition.Ī variety of complications have been reported in patients with acromegaly including cardiovascular diseases, such as hypertrophic cardiomyopathy, heart failure, hypertension, diabetes mellitus or respiratory disorders, obstructive sleep apnoea as well as increased risk of benign and malignant neoplasms including colon cancer. GH stimulates the liver to produce Insulin like growth factor 1 (IGF-1). 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 1, P 1, P < 0.001) as compared to the control group.Īcromegaly is caused by a pituitary somatotroph adenoma and characterised by excessive secretion of growth hormone (GH). 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.
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