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PubMed1984

Comparison of cholecystokinin release and gallbladder emptying in men and in women at estrogen and progesterone phases of the menstrual cycle.

Why are gallstones more common in women than in men? To investigate this, we measured gallbladder emptying (by ultrasonography) and release of endogenous cholecystokinin (CCK) (by specific radioimmunoassay) in eight men and nine women in response to ingestion of corn oil (1 gm/kg). Each woman was studied on the fourteenth and twenty-first day of her menstrual cycle, estimated to be the estrogen (women [E] ) and progesterone (women [P] ) peaks, respectively. Fasting plasma concentrations of CCK were significantly higher in women (E) (135 +/- 7 pg/ml) than in men (99 +/- 13 pg/ml) but not significantly higher than in women (P) (113 +/- 11 pg/ml). The peak increase in CCK concentration over basal concentration and the integrated release of CCK were not significantly different from one group to another. Men had a larger fasting gallbladder volume (GBV) (21.4 +/- 3.2 ml) than did women (E) (12.4 +/- 2.1 ml) and women (P) (14.2 +/- 2.1 ml) and emptied more GBV in response to fat than did the women. The residual GBV and fractional emptying after ingestion of corn oil were not different among the three groups. Measurements of plasma CCK and GBV during the contraction phase were highly correlated in all groups. It appears, from these data, that the increased prevalence of gallstones in women relative to men cannot be explained on the basis of significant differences either in release of CCK or in gallbladder motility. Linear regression lines that were developed indicated that the mean change in GBV relative to a given change in plasma CCK was significantly higher in men than in women. Differences between men and women in this hormonal-motility relationship may contribute to the incidence of gallstones in premenopausal women.

Adult↗
PubMed1994

Effect of cigarette smoking on gallbladder emptying and filling in man.

OBJECTIVE: The effect of cigarette smoking on gallbladder (GB) emptying and refilling after a fatty meal was examined in 10 healthy volunteers (four women and six men, mean age 27.6 yr). METHODS: On three different days, the subjects underwent in randomized order: a control test without smoking (C), or they smoked two cigarettes during the early (0-20 min; S0-20), or late (20-40 min; S20-40) phase of the meal-induced GB emptying. GB volumes were measured ultrasonographically before the meal and at 10, 20, 30, 40, 60, 90, 120, 150, and 180 min postprandially. Two-way ANOVA was applied for statistical assessment of the results. RESULTS: The fasted GB volumes amounted to 15.7 +/- 1.8 cm3 (C), 15.0 +/- 1.7 cm3 (S0-20), and 18.4 +/- 2.3 cm3 (S20-40), F2;18 = 1.524, NS. Maximum GB emptying was observed until 60 min after the meal, with a nadir of the GB volume amounting to 7.3 +/- 1.3 cm3 (C), 6.6 +/- 1.2 cm3 (S0-20), and 7.1 +/- 1.1 cm3 (S20-40). No significant difference was found between the stimuli tested when absolute GB volumes were considered: F2;180 = 2.725, NS. Analysis of the GB emptying-refilling curves normalized for the fasted GB volume revealed that a significant inhibitory effect was produced by smoking two cigarettes during the late phase of GB emptying on the subsequent GB refilling: F2;162 = 11.066, p < 0.001 for the whole curve, and F2;72 = 7.126, p < 0.005 for the refilling phase. A significant contrast was found next between S20-40 and the control day (p < 0.001 whole curve; p < 0.005 refilling phase only), as well as between S20-40 and S0-20 (p < 0.001 whole curve; p < 0.025 refilling phase only). CONCLUSION: We conclude that smoking two cigarettes does not disturb the fatty meal-induced GB contraction in healthy humans. Subsequent GB refilling is delayed if smoking takes place during the late phase of the postprandial GB contraction.

Adult↗
PubMed1986

The empty gallbladder syndrome--results of operation for noncalculous biliary disorders.

Based on results of long-term follow-up and pathophysiologic considerations in 38 consecutive patients, it was possible to speculate on the frequencies of the various causes of the empty gallbladder syndrome. In approximate percentages, these are as follows: bile stasis causing chronic acalculous cholecystitis, 47%; physiologic dysfunction of the gallbladder, 24%; psychogenic illness, 16%; sphincter of Oddi dysfunction, 13%; ulcerative colitis, 3%. Because as many as 30% to 35% of these patients will not benefit from cholecystectomy, I feel that it should be undertaken with caution in cases of this syndrome.

Adolescent↗
PubMed1983

Effect of Morphine and butorphanol on gallbladder emptying.

In the search for the most appropriate analgesic for patients with biliary tract and pancreatic pain, the authors compared the effect of morphine and the opiate agonist-antagonist butorphanol on gallbladder contraction and emptying stimulated by cholecystokinin octapeptide. Morphine markedly inhibited gallbladder emptying while butorphanol only slightly delayed it. Compared with morphine, the effect of butorphanol was minimal; the latter, therefore, seems to be a suitable analgesic for the treatment of pain of biliary tract or pancreatic origin.

Adult↗
PubMed1987

[Study of gallbladder emptying using 99m Tc-HIDA in acalculous cholecystopathy].

So-called acalculous gallbladder disease is an ill-defined entity, mainly seen in young women, which could be due to a motility disorder of the biliary tract. Seven young women with relapsing pain in the right upper quadrant of the abdomen or in the epigastrium, with cholesterol crystals in the bile and with normal sonographic and radiologic findings as well as normal gastroscopy, were investigated by hepato-biliary scintigraphy with 99mTc-HIDA. This first group was compared with a second group of 6 young women suffering from irritable colon, and with a third group of 6 asymptomatic control subjects. The half emptying-time of the gallbladder after cholecystokinin injection was 104.36 +/- 43.93 minutes in the first group, 17.92 +/- 23.57 minutes in the second and 20.42 +/- 23.67 minutes in the third group (p less than 0.005). After 6 weeks of ursodeoxycholic acid treatment, regression of pain and a significant reduction in the half emptying-time from 104.36 +/- 43.93 to 74.35 +/- 52.79 minutes (p less than 0.01) was observed in the first group. These results, which need to be confirmed by further studies, show that in acalculous gallbladder disease there is a delay in gallbladder emptying which could explain the formation of cholesterol crystals by bile stasis as described by various authors.

Adult↗
PubMed1995

[Interdigestive gallbladder volume and and meal-induced gallbladder emptying in patients with diabetes].

The aim of the study was to find whether the type of diabetes and the duration of this disease causes any influence on gallbladder (GB) emptying, after exclusion of possible effect of obesity and a hyperglycaemia over 7 mmol/l (126 mg%) on this phenomenon. The investigations were carried out in 44 subjects with diabetes mellitus, among them 22 with type I and 22 with type II. These groups were divided according to disease duration: shorter or longer than 3 years. Two control groups (CI, CII) comprised each 20 healthy subjects. The age of CI and CII corresponded to the age of diabetes groups type I and II, respectively. All subgroups as well as the control groups were matched according to sex percentage structure, body mass index (BMI) and body surface (BS). In groups with type I and II diabetes, the number of cases with diabetic neuropathy was comparable. There was not found any significant (p > 0.05) influence of diabetes on the interdigestive GB volume, neither non-standardized nor standardized with regard to standard BS (1.73 m2). In comparison to the control groups, after a test meal, there was in all diabetic groups a statistically significant (0.001 > p < 0.05) reduction of GB emptying observed. This diminution was most expressed in the group with long-lasting type I diabetes.

Adult↗
PubMed1986

Gallbladder emptying in man related to fasting duodenal migrating motor contractions.

Animal studies have shown that the gallbladder (GB) empties partially during fasting in relation to phase II of the interdigestive motor cycle (IDMC). It has been assumed that in man the GB remains inert during fasting, although there have been no studies in which repeated sequential measurements of gallbladder volume have been made and related to the IDMC. In this study the possibility of linkage between the IDMC and GB volume has been examined in nine fasting human volunteers (five males/four females). A multilumen constantly perfused manometry catheter was positioned in the duodenum and motor activity recorded continuously. Phase III of the IDMC was characterized by phasic contractions, with a frequency of 10-12/min for at least 2 min, which had a distal propagative pattern and were followed by a motor quiescence (Phase I). GB volume was calculated at 15 min intervals from ultrasound measurements of the maximal length and diameter of the GB by the summation of cylinders method, and related to the time of onset of each phase III of the IDMC. In all nine subjects GB volume decreased prior to the onset of phase III and increased following its passage (P less than 0.01). GB volume decrease ranged between 6 and 56% of maximal GB volume (median 18%) and subsequent filling ranged from 14 to 53% (median 27%). The maximal volume decrease occurred 30 min prior to the onset of phase III (P less than 0.02). These studies have demonstrated that the human GB empties partially during phase II of the IDMC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Effect of erythromycin on gallbladder emptying in patients with antrectomy or truncal vagotomy.

OBJECTIVES: Erythromycin, a motilin-like agent, stimulates gallbladder contraction in healthy control subjects. Because the action of erythromycin is cholinergic dependent and possibly related to premature phase III migrating motor complex activity in the antrum, we investigated the effect of erythromycin on gallbladder volume in six patients with truncal vagotomy without gastric resection and 14 patients with antrectomy (6 with Billroth I anastomosis, 8 with Billroth II anastomosis), and we compared the results obtained with those in eight healthy controls. In addition, the effect of meal ingestion on gallbladder volume was studied. METHODS: Gallbladder volumes, measured with ultrasonography, were determined every 15 min for 180 min after erythromycin infusion (3 mg/kg i.v.), as well as 30 and 60 min after meal ingestion. RESULTS: Basal gallbladder volumes were not significantly different among the four groups. Erythromycin induced a significant (p < 0.01-0.05) gallbladder contraction of maximal 46 +/- 6% in the controls, 49 +/- 9% in the patients with truncal vagotomy, and 38 +/- 7% in the patients with antrectomy and Billroth I anastomosis. In the patients with antrectomy and Billroth II anastomosis, no significant reduction in gallbladder volume after erythromycin was observed. Meal-induced gallbladder contraction was normal in all patients, including those with Billroth II anastomosis. CONCLUSIONS: These results indicate that neither the long vagus nerve nor the antrum is essential for erythromycin-induced effects on the gallbladder. Because no significant reduction in gallbladder volume in response to erythromycin was observed in the patients with antrectomy and Billroth II anastomosis, we suggest that duodenojejunal anatomical integrity is essential for erythromycin-induced gallbladder contraction.

Adult↗
PubMed2001

[The effect of long-term administration of isosorbide 5-mononitrate (Mononit), nitric oxide donor, on gallbladder emptying in patients with chronic stable angina].

In 13 patients (7 females and 6 males) with newly found, previously not treated, chronic stable angina the interprandial volume of the gallbladder and its emptying after treatment with isosorbide-5-mononitrate (Mononit) were examined. The volume of gallbladder was estimated with ultrasonography first after administration of 10 or 20 mg of Mononit twice a day and then in 3rd and 6th week of treatment. It was found that the intake of the single dose as well as the long treatment with Mononit had no effect on interprandial volume of gallbladder. However the intake of drug led to the significant inhibition of postprandial gallbladder's contractility both after the single dose and long term treatment with Mononit.

Aged↗
PubMed1997

Physiological role of nitric oxide in gallbladder emptying in men.

This study was designed to determine the role of nitric oxide in gallbladder (GB) contractions in men. The studies were performed in 10 young healthy male volunteers. GB emptying was examined by ultrasonography under basal conditions and after intravenous infusion of cholecystokinin (CCK8; 12.5 pmol/kg x h) or yolk intake in tests without (saline) and with intravenous infusion of NG-monomethyl-L-arginine (L-NMMA; 4.0 micromol/kg x h) and/or L-arginine (1 mmol/kg x h). The plasma CCK level was determined by radioimmunoassay. It was found that the basal GB volume was about 27 +/- 3 ml, and after CCK8 infusion or yolk meal this volume was reduced within about 30 min by about 93 and 80%, respectively. Pretreatment with L-NMMA caused reduction of the baseline volume by about 15% and significantly augmented the GB emptying induced by CCK8 infusion and yolk intake. L-Arginine alone failed to affect basal or stimulated (CCK or yolk) emptying of the GB, but when combined with L-NMMA, it reversed the enhancement of GB contraction caused by L-NMMA. The basal plasma CCK level was 1.2 +/- 0.3 pmol/l and rose to 7.9 +/- 2.1 pmol/l with CCK8 infusion and to 4.7 +/- 1.8 pmol/l after yolk meal. No significant change in plasma CCK levels was observed in tests with L-NMMA and/or L-arginine. We conclude that under physiological conditions, the GB contractile activity is regulated predominantly by CCK, but endogenous nitric oxide has a tonic relaxing influence on this activity.

Adult↗
PubMed1997

Variability of gallbladder emptying after oral stimulation.

BACKGROUND: To date, the intraindividual reproducibility of fasting and postprandial gallbladder (GB) volumes has not been established satisfactorily. Hence we examined the variability of postprandial GB motility, using the biplane Simpson method as a new sonographic tool for GB volume determination. METHODS: The biplane Simpson method was validated in vitro and in vivo and compared with the sum-of-cylinders method. Thereafter, postprandial GB emptying after a defined test meal was examined in 10 healthy volunteers over 108 min on days 1, 31, and 61. RESULTS: The results of the biplane Simpson method correlated with real volumes (r = 0.99) and provided a intra- and inter-observer variation of less than 5%. Intraindividually, differences in fasting GB volume ranged from 1.9 to 24.0 ml within the observation period. The patterns of GB emptying also showed fluctuations characterized by a rather large interindividual and intraindividual variability. CONCLUSIONS: The biplane Simpson method is a reliable tool for measuring GB volumes. The fasting and the postprandial GB volumes vary considerably within individuals when measured over a period of 2 months.

Adult↗