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PubMed2003

Changes in gallbladder motility and gallstone formation following laparoscopic gastric banding for morbid obestity.

UNLABELLED: Morbid obesity is associated with cholesterol gallstone formation, a risk compounded by rapid weight loss. Laparoscopic gastric banding allows for a measured rate of weight loss, but the subsequent risk for developing gallstones is unknown. METHOD: Twenty-six normal-weight volunteers (body mass index [BMI] less than 30) were compared with 14 morbidly obese patients (BMI greater than 40). Gallbladder volumes were measured ultrasonographically, after fasting and following stimulation with intravenous cholecystokinin-octapeptide (CCK-8) RESULTS: Preoperatively, fasting gallbladder volume and residual volume after CCK stimulation were both two times greater in the obese group (P<0.02 versus controls). Per cent gallbladder emptying was not different. Gallbladder refilling was four times higher in the obese patients (P<0.01). By six weeks postoperatively, the obese patients lost 1.4+/-0.1% body weight per week. Gallbladder emptying decreased 18.4% (80.3+/-3.9% to 65.5+/-6.9%; P<0.05); residual volume rose one-third (not significant), and refilling fell 60.5% (0.43+/-0.09 to 0.26+/-0.04 mL/min; P=0.07). Three patients with weight losses of greater than 1.7% per week developed gallstones; gallbladder emptying fell outside the 95 percentile. By six months, weight loss slowed to 0.5+/-0.1% per week; gallbladder motility improved modestly. No further stones developed. CONCLUSION: Rapid weight loss following laparoscopic gastric banding impairs gallbladder emptying and when pronounced, gallstones form by six weeks postoperatively. The accompanying reduction in gallbladder emptying, increased gallbladder residual volume and decreased refilling promote gallbladder stasis and hence stone formation.

Adult↗
PubMed2004

Biliary dyskinesia: a potentially unrecognized cause of abdominal pain in children.

Biliary dyskinesia is defined as symptomatic biliary colic without cholelithiasis, and is diagnosed during cholescintigraphy by assessing gallbladder emptying with cholecystokinin (CCK) stimulation. Unfortunately, gallbladder emptying is not routinely assessed during cholescintigraphy in pediatric patients. The purpose of this review is to assess the effectiveness of cholecystectomy in patients with chronic abdominal pain and delayed gallbladder emptying and to assess whether these findings correlate with the histologic evidence of chronic cholecystitis. We retrospectively reviewed the medical records of all patients ( n=16) at our institution from October 1997 to August 2001 who underwent quantitative cholescintigraphy with CCK stimulation that demonstrated delayed gallbladder emptying (< 35% at 60 min) and who subsequently underwent cholecystectomy. Laparoscopic cholecystectomy was performed in 16 patients with chronic abdominal pain. All 16 patients had delayed gallbladder emptying (mean ejection fraction: 15+/-8%, range: 3-32%). The mean age was 12+/-2 years (range: 8-17 years). Presenting symptoms included abdominal pain (86%), fatty food intolerance (27%), emesis (13%), and diarrhea (13%). Mean duration of abdominal pain before operation was 11+/-19 months (range: 2 weeks-6 years). One patient's symptoms persisted postoperatively, but abdominal pain resolved in all other patients. Histologic evidence of chronic cholecystitis was demonstrated in 86% of surgical specimens. Five patients underwent concurrent appendectomy, and all had normal appendiceal histology. Our experience suggests that children with chronic abdominal pain and delayed gallbladder emptying on CCK-stimulated cholescintigraphy are likely to benefit from cholecystectomy and to have histologic evidence of chronic cholecystitis.

Abdominal Pain↗
PubMed1995

[Intraindividual reproducibility of ultrasound detection of gastrobiliary motility parameters and CCK incretion after a standardized, liquid, fat-containing test meal].

AIM AND METHODS: Gastric emptying, antral mobility, fasting gallbladder volumes, gallbladder emptying rates, and CCK incretion following a standardized liquid fatty meal were investigated in 14 healthy young volunteers (seven women and seven men) on two separate study days. In the seven young women, taking oral contraceptives, one study day was in the oestrogen phase and the other in the gestagen phase of their menstrual cycle. RESULTS: There was good intraindividual reproducibility of the different sonographic gastrobillary motility parameters and the postprandial CCK incretion in both sexes (coefficients of reliability between 0.80 and 0.98). A significant effect of the menstrual cycle phase in young women was not evident. Instead of this a wide interindividual range of motility parameters, especially of gastric residual volumes in young women, could be obtained. There was no close correlation between gastric emptying rates or the amounts of the fat induced cholecystokinin incretion and gallbladder emptying rates, indicating the relevance of additional cholecystokinin-independent preduodenal mechanism for the regulation of physiological digestive gallbladder emptying.

Adult↗
PubMed2000

Effects of exercise training on gallbladder function in an obese female population.

PURPOSE: Aerobic exercise may influence gallstone disease pathogenesis through its effect on gallbladder motility. The purpose of this investigation was to examine the effects of exercise training on gallbladder emptying in obese women. METHODS: Twenty-seven obese subjects were randomized into one of two groups: exercise (E) (five 45-min brisk walking sessions per week at 75.2 +/- 0.5% of maximum heart rate) and controls (C). Gallbladder function via cholescintigraphy, cardiorespiratory fitness, and body composition were measured in all subjects before and after a 12-wk intervention period. In each cholescintigraphy trial subjects ingested an 8-oz liquid meal 45 min after injection of 99mTc disofenin to promote gallbladder emptying. Gallbladder areas were then scanned for 60 s and then every 5 min for 60 min. RESULTS: VO2max increased significantly by 9% for E when compared with that for C (P < 0.001). Within E postprandial gallbladder ejection fraction (EF) increased significantly after training (39.5 +/- 4.9% to 54.7 +/- 6.5%, P < 0.05); however, this 15.2% increase in EF was not significantly greater than the change reported in the controls. CONCLUSIONS: Results indicate that 12 wk of moderate exercise training does improve cardiorespiratory fitness but does not significantly effect gallbladder emptying in obese women.

Adult↗
PubMed1997

Effect of endoscopic sphincterotomy on gallbladder motility.

In experimental animals, sphincterotomy facilitates passage of solids from the gallbladder and inhibits gallstone formation apparently by improvement in gallbladder emptying. In humans, however, gallbladder emptying has not been studied following endoscopic sphincterotomy (ES) in patients with gallstones. We therefore prospectively studied resting and cerulin-stimulated gallbladder volumes by real time ultrasonography in 15 patients of choledocholithiasis with gallbladder in situ (eight with and seven without gallbladder calculi) before and after (after bile duct clearance) ES. ES significantly lowered resting gallbladder volume (21.2 +/- 10.6 vs 11.1 +/- 5.0; P < 0.0001) and cerulin-stimulated residual gallbladder volume (10.8 +/- 5.6 vs 4.4 +/- 2.1; P < 0.0001). ES also significantly increased the gallbladder ejection fraction (47.3 +/- 12.1% vs 58.8 +/- 11.1%; P < 0.0001). The rate constant for gallbladder emptying after cerulin infusion also increased significantly after ES (-0.022/min vs -0.031/ min; P < 0.0001). Significant improvement in gallbladder motility was observed in both groups of patients with and without gallbladder calculi. ES significantly improves gallbladder motility in humans.

Adult↗
PubMed1993

[Ultrasound study of gallbladder motility in healthy subjects. Reproducibility of the method and effect of alcohol].

The protective effect of alcohol against cholesterol cholelithiasis has been established in several epidemiologic studies. An impairment of gallbladder motility in gallstone disease has been demonstrated in animals and in man. At a daily dose of 39 g, alcohol reduces the lithogenic index of bile, but its effect on gallbladder motility is still debated. To test this potential mechanism, the effect of 20 g of alcohol on gallbladder motility was studied, using an ultrasonographic ellipsoid method in 16 healthy male subjects. The stimulus for gallbladder contraction was a Lundh test meal. Using a cross over method, this meal was ingested by each subject once with water and once with alcohol. A third set of measurements was taken in each subject after ingestion of a Lundh meal and water to test the reproducibility of the sonographic method. The gallbladder kinetics were studied for 90 minutes following ingestion of the test meal and beverage. Alcohol stimulated rapid post prandial gallbladder emptying, and accelerated gallbladder filling. This second action could result from sphincter of Oddi pressure enhancement and, perhaps, decrease of gallbladder absorption by Na+ K+ ATPase inhibition. The reproducibility of the method was good. With a decrease of lithogenic bile index, the protective effect of alcohol against biliary cholesterol cholelithiasis could be due either to stimulation of gallbladder emptying and/or acceleration of gallbladder filling.

Adolescent↗
PubMed2003

Ultrasonography in the assessment of gallbladder motor activity.

Ultrasonography is an accurate and useful method for studying gallbladder volume variations and thus indirectly gallbladder emptying and refilling in humans. It has been shown that gallbladder main motor function is the result of a bellows-like mechanism with outflow and inflow of bile occurring during continuously alternating phases of gallbladder emptying and filling, that in turn lead to bile recycling within the gallbladder. Therefore, bile flux through the gallbladder cannot be properly expressed by time and rate of gallbladder emptying and gallbladder ejection fraction. In an attempt to analyse the gallbladder volume-hepatic bile flux relationship, simultaneous assessment of the gallbladder volume variations at ultrasonography and of the labelled bile in the gallbladder at cholescintigraphy during continuous infusion of an hydroxy iminodiacetic acid compound has been carried out. By applying a mathematical model to the analysis of gallbladder volume ultrasonography measurements, it is possible to measure the flux of bile through the gallbladder. By validating ultrasonography assessment of gallbladder volume variations with quantitative cholescintigraphy, it has been shown that the single non-invasive ultrasonography technique with serial frequent measurements of the gallbladder volume enables separate estimation of the flux of bile through the gallbladder in humans and in physiological conditions. In the postprandial state, hepatic bile was mainly: (1) stored in the gallbladder in a first phase; (2) emptied from the gallbladder in a second phase; and (3) stored in the gallbladder in a third phase. The amount of bile flowing bidirectionally through the cystic duct was about fivefold greater than that estimated with the usually employed variables, such as gallbladder ejection fraction or emptying and refilling delta volume. The mathematical analysis of minute-by-minute ultrasonography measurements of gallbladder volume variations yields both physiological and pathological insights. In healthy volunteers, it has been shown that: (1) caloric content of meals affects the total amount of bile recycled by the gallbladder; and (2) fat content of meals affects the modality of gallbladder emptying and refilling but does not affect the total amount of bile recycled by the gallbladder. In gallstone patients, a decreased turnover of bile has been shown which may contribute to cholesterol crystal precipitation and stone growth. In conclusion, unlike conventional variables used to assess gallbladder motor function such as gallbladder ejection fraction and rate of gallbladder emptying, mathematical analysis of frequent ultrasonography measurements of gallbladder volume variations enables non-invasive estimation of bile flow through the gallbladder in normal and abnormal physiological conditions.

Bile↗
PubMed1992

Effect of oral erythromycin on gallbladder motility in normal subjects and subjects with gallstones.

The action of the motilin receptor agonist erythromycin on human gallbladder contraction, measured by ultrasound, both in normal subjects and those with gallstone disease was studied. In 17 normal subjects, oral erythromycin administration (500 mg; vs. placebo) reduced fasting gallbladder volume at 2 hours (26.2 vs. 19.0 mL; P less than 0.001), and postprandial residual gallbladder volume (9.0 vs. 4.4 mL; P less than 0.001) and the rate constant of gallbladder emptying following the meal was significantly increased. Erythromycin also reduced fasting and residual gallbladder volumes in 13 patients with gallstone disease: in 6 who underwent cholecystolithotomy, fasting volume was 29.5 vs. 22.3 mL (P less than 0.05) and residual volume was 17.7 vs. 6.5 mL (P less than 0.05), and in 7 with gallstones in situ, fasting volume was 23.8 vs. 14.3 mL (P less than 0.05) and residual volume was 17.2 vs. 5.0 mL (P less than 0.05). In 7 of 8 subjects with gallstones and impaired gallbladder emptying, the gallbladder emptied normally following administration of erythromycin, and in 3 of the other 5 gallstone subjects gallbladder emptying was increased. In 6 normal subjects given erythromycin three times weekly for 1 month, the effect was maintained (fasting volume, 18.8 mL, P less than 0.001; residual volume, 3.7 mL, P less than 0.001). Oral erythromycin significantly reduces fasting and postprandial residual gallbladder volumes in both normal subjects and subjects with gallstones and reverses the gallbladder motility defect found in a proportion of subjects with gallstones. This effect is maintained for a month in normal subjects.

Administration, Oral↗
PubMed2006

Ultrasound examination shows disturbed proximal gastric function in symptomatic gallstone patients with dyspepsia and improvement after cholecystectomy--gallstones and gastric emptying.

AIM: The aim of our study was to examine gastric function, gallbladder emptying, and dyspepsia in symptomatic gallbladder stone patients (SGBS) to see if a motility disorder, expressed by gastric function and gallbladder emptying, may cause dyspepsia in SBGS. MATERIALS AND METHODS: Gastric function and gallbladder emptying in 21 SGBS referred for surgical treatment were measured by ultrasound after ingestion of 500 ml of a meat soup (bouillon). Dyspeptic symptoms were simultaneously recorded on a Visual Analog Scale (VAS). The patients were re-examined 10 months after cholecystectomy. Hospital staff (n = 14) served as control subjects (C). RESULTS: In SGBS, the frontal diameter of the proximal stomach was wider than in C at both 10 minutes (55.7 vs. 48.3 mm; p = 0.053) and 20 minutes (49.3 vs. 39.5 mm; p = 0.002), and the sagittal area of the proximal stomach was larger at 10 minutes (25.0 vs. 20.9 cm (2); p = 0.03). The postprandial frontal diameter decreased significantly after cholecystectomy (immediately after the meal: 51.3 mm; p = 0.03, at 10 minutes: 47.6 mm; p = 0.05, and at 20 minutes: 39.1 mm; p = 0.004). Twenty minutes after meal ingestion, gallbladder emptying was significantly less in SGBS than in C with a mean (SD) emptying of 20 % (17) versus 33 % (18); p < 0.04. In the fasting state, SGBS felt more hunger than C (VAS 67 mm vs. 39 mm; p = 0.03). After cholecystectomy, the feeling of hunger decreased (VAS 27 mm; p = 0.01). CONCLUSION: SGBS had a wider proximal stomach and more hunger in the fasting state than C. After cholecystectomy the proximal stomach function and the hunger score improved. Our results suggest a physiological link between symptomatic gallstone disease and dyspepsia expressed by impaired proximal gastric function.

Adult↗
PubMed1993

Gallbladder dysfunction in diabetes mellitus.

To further elucidate the mechanism of impaired gallbladder emptying in diabetics with and without neuropathy, gallbladder function was assessed by ultrasonography following a medium-chain triglyceride (lipomul, 1.5 mg/kg) infusion into the duodenum and compared to that during intravenous infusion of cholecystokinin in diabetic women. Results were compared with five healthy control women. Mean (+/- SD) maximal percent gallbladder volume in diabetics following lipomul was reduced to 49 +/- 8% and after intravenous cholecystokinin to 47 +/- 9%, which was less than those in controls, 21 +/- 9% and 24 +/- 6%, respectively, but not significantly different. Further analysis of gallbladder emptying to lipomul differentiated two subgroups of diabetics: one subgroup (N = 5) had emptying comparable to controls (responders), while the other (N = 5) had very modest emptying (nonresponders). Two of the patients in the latter group had normal gallbladder emptying during exogenous cholecystokinin and their response would be compatible with visceral neuropathy. Blood levels of cholecystokinin, measured by bioassay, following lipomul and exogenous cholecystokinin were similar in controls and diabetics. Presence of diabetic neuropathy did not correlate with impaired gallbladder emptying. Follow up at 6 and 12 months of the three nonresponder diabetics revealed that no gallstones had developed and that two of them became responders to exogenous cholecystokinin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

[Gallbladder kinetics in the black African subject with and without cholelithiasis. An ultrasonographic study].

PURPOSE: Gallbladder hypomotility could play a significant role in the process of lithogenesis, but this role has yet to be defined in black African populations. This role was assessed by measuring gallbladder emptying after stimulation by a fat meal in a group of black African subjects with and without cholelithiasis. MATERIALS AND METHODS: Fifteen subjects with cholelithiasis and thirty controls divided in two pools were studied. Gallbladder emptying was stimulated by fat meals of 610 and 740 Kcal, and was measured with ultrasound for a period of 120 min. RESULTS: The mean fasting gallbladder Volume of the subjects with lithiasis was significantly superior to that of the controls. Compared to what has been previously published in Caucasian subjects, gallbladder emptying was generally more rapid in our study. Further more, gallbladder emptying was significantly better in the control group than in the group of subjects with cholelithiasis. Two groups of subjects with cholelithiasis were isolated. The first group had poor gallbladder emptying and normal fasting gallbladder Volume; the second had normal gallbladder emptying but significantly increased fasting gallbladder Volume. CONCLUSION: Impaired gallbladder emptying and/or increased fasting gallbladder Volume probably play a role in lithogenesis. Hypomotility seems to play a significant role only for those subjects with normal fasting gallbladder Volume.

Adult↗
PubMedDate not supplied

Emptying the gallbladder prior to intravenous cholangiography: effect on gallbladder visualization.

Experiments were done to test the hypothesis that emptying the gallbladder prior to intravenous cholangiography (IVC) would result in earler and better opacification of the gallbladder. Five dogs were studied on two separate days in a crossover experiment. Each dog had a standard IVC (15-minute infusion of meglumine iodipamide) 2.5 cc/kg of following a 14-16-hour fasting period. On one of the days, 0.3 mcg/kg of Ceruletide was intramuscularly administered to each dog 30 to 45 minutes prior to the iodipamide infusion. Films obtained at the end of infusion and at 20, 40, 60, and 90 minutes were evaluated independently by three radiologists. The results indicate that pretreatment with Ceruletide produces a significant (p less than 0.05) improvement in the quality of gallbladder opacification during the first 90 minutes following iodipamide infusion. We conclude that earlier and better opacification of the gallbladder during IVC can be obtained by prior emptying of the gallbladder with a cholecystokinetic agent.

Animals↗
PubMed1996

Pharmacological profile of T-0632, a novel potent and selective CCKA receptor antagonist, in vivo.

The pharmacological profile of a new CCKA receptor antagonist, T-0632 [sodium (S)-1-(2-fluorophenyl)-2,3-dihydro-3-[(3-isoquinolinylcarbonyl) amino]-6-methoxy-2-oxo-1H-indole-3-propanoate], was examined in in vivo studies and compared with those of L-364, 718 [3S(-)-N-(2,3-dihydro-1-methyl-2-oxo-5-phenyl-1H-1, 4-benzodiazepine-3-yl)-1 H-indole-2-carboxamide] and loxiglumide [D.L-4-(3,4-dichlorobenzoylamino)-5-(N-3-methoxypropyl-pentylam ino)-5- oxopentanoic acid]. In rats, intravenously administered T-0632, L-364,718 and loxiglumide dose dependently inhibited cholecystokinin octapeptide (CCK-8)-stimulated pancreatic exocrine secretion with estimated ED50 values of 0.025, 0.016 and 1.8 mg/kg, respectively. The ED50 values for intraduodenal administration of these compounds were 0.040, 0.26 and 3.0 mg/kg, respectively. In mice, orally administered T-0632 prevented caerulein-induced pancreatitis, CCK-8-induced inhibition of gastric emptying and CCK-8-induced gallbladder emptying in dose-dependent manners with ED50 values of 0.028, 0.04, and 0.12 mg/kg, respectively. The effect of T-0632 for caerulein-induced pancreatitis was 4-fold more potent than that for gallbladder emptying. In contrast, the effects of L-364,718 and loxiglumide for caerulein-induced pancreatitis were 2-4-fold weaker than those for gallbladder emptying. In dogs, T-0632 and loxiglumide maximally inhibited CCK-8-stimulated pancreatic amylase secretion at doses of 0.01 and 10 mg/kg, respectively. At these doses, the effect of T-0632 on CCK-8-induced increase in the gallbladder intraluminal pressure was weaker than that of loxiglumide. These results suggest that T-0632 has a potent antagonistic action on CCKA receptors in several animal species and the effects of T-0632 are more selective for the pancreas over the gallbladder compared with L-364,718 and loxiglumide.

Animals↗
PubMed1989

Plasma cholecystokinin and gallbladder responses to intraduodenal fat in gallstone patients.

Impaired gallbladder emptying is one of the various factors suggested to be involved in the pathogenesis of gallstones. The present study was undertaken to determine whether gallbladder emptying, endogenous cholecystokinin (CCK) secretion, or their interrelation is altered in patients with gallstones. After intraduodenal administration of 60 ml corn oil, plasma CCK concentration was measured by a sensitive and specific radioimmunoassay and gallbladder emptying by cholescintigraphy. Patients with gallstones (N = 20) produced significantly less endogenous CCK (105 +/- 17 pmol/liter 60 min; P less than 0.001) than control subjects (191 +/- 11 pmol/liter 60 min, N = 20); gallbladder emptying in the patients was significantly decreased at 5, 10, 40, 45, and 50 min but the reduction in gallbladder emptying did not reach statistical significance at 60 min (patients 44 +/- 8%, control subjects 60 +/- 4%). In addition, the gallbladder responsiveness to intravenous infusion of the synthetic CCK analog cerulein was investigated. Based on the results of gallbladder emptying in response to endogenous and exogenous CCK, four subgroups of gallstone patients were identified: (1) a group (N = 7) with normal gallbladder sensitivity to CCK, (2) a group (N = 6) with significantly increased gallbladder sensitivity to CCK, (3) a group (N = 6) with impaired gallbladder emptying after corn oil due to a significantly reduced endogenous CCK secretion but with normal gallbladder sensitivity to CCK, and (4) one patient whose gallbladder was unresponsive to CCK and was found to have chronic cholecystitis at surgery.

Ceruletide↗
PubMed1982

Changes in gallbladder motor function during the female cycle--a risk factor leading to gallstone formation?

The gallbladder volume of eight women with stable cycles was determined by sonography. Furthermore, gallbladder contraction--following an orally administered fatty meal and the spontaneous refilling of the empty gallbladder--was quantitatively examined. The formula of a rotation ellipsoid, which has been proven to be adequately accurate in in vitro studies, was used for calculating the gallbladder volume. In the gestagen phase (21st or 22nd day) the intraindividual studies showed greater fasting volumes, higher residual volumes after contraction, slower gallbladder emptying, and retarded refilling of the empty gallbladder as compared to the estrogen phase (12th or 13th day). The hormonally modified contraction behavior and the differing course of gallbladder filling may play a major role in the pathogenesis of gallstone formation.

Cholelithiasis↗
PubMed1997

Gallbladder motility and lithogenicity of bile in patients with choledocholithiasis after endoscopic sphincterotomy.

BACKGROUND/AIMS: Ablation of the sphincter of Oddi has been shown to inhibit gallstone formation in the prairie dog model, probably by alleviating gallbladder bile stasis. The effect of endoscopic sphincterotomy (ES) on gallbladder emptying and lithogenicity of bile has not been studied adequately in humans. We, therefore, studied the changes in gallbladder emptying and lithogenicity of bile following ES in patients with choledocholithiasis and gallbladder in situ. METHODS: Thirteen patients with choledocholithiasis with intact gallbladder underwent ES and common bile duct clearance. Eight patients had concomitant gallstones. Gallbladder emptying was studied by real time ultrasonography after stimulation by ceruletid infusion. Fasting gallbladder bile was collected during endoscopic retrograde cholangiography by placing a 7F or 8F catheter in the common bile duct and after ceruletid stimulation of gallbladder for bile microscopy and cholesterol nucleation time determination. Gallbladder emptying, nucleation time and bile microscopy were performed before ES and again between 4 and 8 weeks after ES after cholangiographic confirmation of clearance of common bile duct stones. RESULTS: Fasting and residual gallbladder volumes decreased and ejection fraction increased significantly following ES, suggesting decreased stasis and improved emptying of gallbladder. Nucleation time was prolonged and cholesterol crystal index in bile decreased after ES, suggesting decreased lithogenicity. The decrease in gallbladder volumes and increase in ejection fraction after ES were observed in both groups of patients, with or without concomitant gallstones. CONCLUSIONS: ES decreases the stasis of gallbladder bile, improves gallbladder emptying and decreases the lithogenicity of bile in patients with gallstone disease as reflected by prolongation in nucleation time. ES may find a role as an adjunct to oral bile acid therapy and extracorporeal shock wave lithotripsy in addition to a prophylactic role of preventing gallstone formation in high risk groups.

Adult↗
PubMed1990

Neurohumoral control of gallbladder motility in healthy subjects and diabetic patients with or without autonomic neuropathy.

Patients affected by diabetes mellitus are reported to have an increased incidence of gallbladder abnormalities. The pathophysiologic mechanisms for this phenomenon are unclear. In the present study ultrasonography was used to determine gallbladder emptying in response to a meal or separate cephalic or hormonal stimulation in 21 diabetic patients and 10 healthy subjects. Gallbladder emptying and refilling after a meal were similar in diabetic patients and healthy subjects. When diabetics were divided according to the presence or absence of cardiac autonomic neuropathy (AN), a significant reduction of gallbladder emptying in response to cephalic stimulation was found in diabetics with AN (P less than 0.01 in comparison with diabetics without AN or healthy subjects). A dose-response curve of gallbladder emptying in response cerulein, a cholecystokinin analog, at concentrations of 0.25, 1, and 4 micrograms/kg/min was evaluated. No differences of gallbladder emptying were found in the three groups of subjects, indicating that gallbladder sensitivity to hormonal stimulation is not changed in diabetic patients with or without AN. Diabetic patients with AN have a significant reduction of gastric acid output and pancreatic polypeptide (PP) secretion in response to cephalic stimulation (P less than 0.05 in comparison with diabetic patients without AN or healthy subjects). Cerulein-induced PP secretion was similar in all three groups of subjects (P greater than 0.05). This study indicates that in diabetic patients with AN, gallbladder emptying as well as gastric acid and PP secretions induced by neural stimulation are markedly reduced in comparison to diabetics without AN.

Adult↗
PubMed1995

[Effect of gastrectomy on gallbladder motility: an experimental study].

Gallstone formation is frequently seen following gastric surgery. Since dysmotility and bile stasis of the gallbladder is considered as an important factor in the pathogenesis of gallstone formation, altered gallbladder motility due to gastric surgery may have a role in the development of post-gastrectomy gallstone formation. To test this hypothesis, the effect of distal partial gastrectomy on gallbladder motility were studied. Gastroduodenal and gallbladder contractions were recorded by chronically implanted strain gauge transducers under conscious state. Gallbladder volume changes were monitored using chronically indwelling gallbladder catheter. Fasted and fed motility were studied in control (n = 5) and gastrectomized (n = 3) dogs. Plasma concentration of putative hormone CCK was measured. Effect of CCK-OP and motilin on gallbladder emptying were also studied. In fasted state, gallbladder volume was periodically decreased synchronous with phase 3 of interdigestive migrating contractions (IMC) in the gastroduodenum in both group of dogs. The correlation between gastric and gallbladder contractions was preserved even following distal partial gastrectomy, though the frequency of phasic contractions during phase 3 of IMC was decreased in the gastrectomized dogs. Postprandial gallbladder emptying tend to decreased in the gastrectomized dogs, while there were no difference in the postprandial plasma CCK concentrations and CCK-OP induced gallbladder emptying between groups. Digestive period was shortened in the gastrectomized dogs, which resulted in early gallbladder refilling and prolonged interdigestive period. Decreased frequency of gallbladder phasic contractions during IMC and prolonged interdigestive period could cause bile stasis in the gallbladder, which may, in part, explain post-gastrectomy gallbladder formation.

Animals↗