Effects of casein on small intestine motility in patients with liver cirrhosis

BACKGROUND: Fasting small bowel motor abnormalities have been described in cirrhotic patients. AIM: To investigate the effects of orally administered casein in small bowel motor activity in cirrhotic patients. PATIENTS AND METHODS: Six healthy subjects and 23 cirrhotic patients were studied. Motility of the upper part of the small bowel was studied by means of perfused manometric catheters, during a basal period and after infusion of 30 g of casein in the stomach. RESULTS: Basal recordings showed a cyclical activity in all healthy subjects and in 9 cirrhotics (further considered as group 1). In 14 patients, basal cyclical activity was absent and were further considered as group II. Frequency of contractions after casein infusion was higher in group II patients than in group I and healthy controls (2.2 +/- 0.3, 1.3 +/- 0.2 and 0.9 +/- 0.2 cpm respectively). Intestinal motor index after casein infusion was also higher in group II. There was a progressive decline with time in motor activity after casein infusion, being maximal at 45 min, in healthy subjects and group I. This decline was not observed in group II. CONCLUSIONS: Patients with cirrhosis have an altered small bowel motor response to casein. Since group II of patients had a greater percentage of Child C patients, the abnormalities seem to be related to the degree of liver failure.