Unexplained gastrointestinal symptoms: Think mitochondrial disease

• Published in: Digestive and liver disease 2014-01, Vol.46 (1), p.1-8
• Main Authors: Chapman, Thomas P, Hadley, Gina, Fratter, Carl, Cullen, Sue N, Bax, Bridget E, Bain, Murray D, Sapsford, Robert A, Poulton, Joanna, Travis, Simon P
• Format: Article
• Language: English
• Subjects: Adolescent; Child; DNA, Mitochondrial - genetics; Female; Gastroenterology and Hepatology; Gastrointestinal Diseases - etiology; Gastrointestinal Diseases - genetics; Gastrointestinal Diseases - physiopathology; Humans; Intestinal Pseudo-Obstruction - genetics; Intestinal Pseudo-Obstruction - physiopathology; Male; Middle Aged; Mitochondrial disease; Mitochondrial Encephalomyopathies - genetics; Mitochondrial Encephalomyopathies - physiopathology; Mitochondrial Myopathies - complications; Mitochondrial Myopathies - genetics; Mitochondrial Myopathies - physiopathology; Optic Atrophy, Autosomal Dominant - complications; Optic Atrophy, Autosomal Dominant - genetics; Optic Atrophy, Autosomal Dominant - physiopathology; Unexplained gastrointestinal symptoms; Young Adult
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2013.04.008

Abstract Defects in mitochondrial function are increasingly recognised as central to the pathogenesis of many diseases, both inherited and acquired. Many of these mitochondrial defects arise from abnormalities in mitochondrial DNA and can result in multisystem disease, with gastrointestinal involvement common. Moreover, mitochondrial disease may present with a range of non-specific symptoms, and thus can be easily misdiagnosed, or even considered to be non-organic. We describe the clinical, histopathological and genetic findings of six patients from three families with gastrointestinal manifestations of mitochondrial disease. In two of the patients, anorexia nervosa was considered as an initial diagnosis. These cases illustrate the challenges of both diagnosing and managing mitochondrial disease and highlight two important but poorly understood aspects, the clinical and the genetic. The pathophysiology of gastrointestinal involvement in mitochondrial disease is discussed and emerging treatments are described. Finally, we provide a checklist of investigations for the gastroenterologist when mitochondrial disease is suspected.