Published online Jun 9, 2020. doi: 10.4292/wjgpt.v11.i2.17
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
Acromegaly results from an excess of growth hormone, which leads to excess secretion of Insulin like growth factor 1 from the liver, causing abnormal soft tissue growth. This is associated with an increase in a number of organic diseases. There is increasing awareness that diseases affecting connective tissue are associated with an increase in functional gastrointestinal symptoms. We are not aware of any other study that has looked into the burden of abdominal symptoms in acromegaly and the impact they have on patient’s quality of life as a result of this.
This study is part of a larger study that is assessing the role and significance of connective tissue involvement in abdominal symptoms. We have previously described an increase in functional gastrointestinal symptoms in other diseases affecting connective tissue (Marfan and Ehlers Danlos). In this study we evaluate the frequency of abdominal symptoms in patients with acromegaly.
The main objective of this study was to evaluate if patients with acromegaly had more frequent and intense abdominal symptoms, as described by the Rome criteria, than controls and thus, as a result of this had poorer quality of life. Furthermore, other factors such as use of Somatostatin analogues, which in itself can cause abdominal symptoms, had to be taken into account. The next step in our research would be to carry out objective gastrointestinal physiological studies in larger groups of patients and controls to see if the presence of symptoms reflects actual physiological variations across different groups.
Patients with acromegaly were identified from a clinical database at one tertiary medical centre (Department of Endocrinology, St George’s Hospital, London). Identified patients were then asked to fill out previously validated questionnaires and results were compared with sex- and age-matched group of controls (recruited from fracture clinic who were otherwise healthy and did not report any other medical problems).
The results of this study showed that the presence of abdominal symptoms in acromegaly is significantly higher than controls. The results also show that the presence of these symptoms has an overall detrimental effect on quality of life or well being of the patient. This study also supports the increasing awareness in the scientific world regarding the association of connective tissue abnormalities and gastrointestinal or abdominal symptoms. It is yet to be seen if gastrointestinal physiological studies in these patients will be reflective of these results.
The presence of abdominal symptoms is significantly higher in patients with acromegaly compared to controls and this may have a significant impact on their quality of life. Connective tissue abnormalities are associated with abdominal symptoms as has been shown by this study and other studies and may be one of the underlying reasons behind functional gastrointestinal disorders (FGIDs). Other studies have shown similar results in Ehlers-Danlos and Marfan syndromes and abnormalities of connective tissue such as elastin may be common to these disease processes. This needs to be studied further to see if minor variations in gut connective tissue the cause of FGIDs could be.
Future research in this area will have to be pursued in an international and multicentre study as it is difficult for one centre to recruit a large number of patients in rare diseases. Gastrointestinal physiological studies would help to see if the variance in symptoms is reflected in physiological variance.