Gallbladder contractility and volume characteristics in gallstone dyspepsia.

AIM It is difficult to differentiate gallstone dyspepsia and functional dyspepsia by clinical symptoms and signs. We hypothesized that gallstone dyspepsia was related to abnormal gallbladder motility. We aimed to differentiate gallstone dyspepsia from functional dyspepsia by measuring gallbladder motility. METHODS We measured gallbladder volume changes in response to gastric distension (saline 500 mL) and fatty meal in 10 normal volunteers (controls) and 62 patients with gallstones and dyspepsia before cholecystectomy. Forty cholecystectomized patients were symptom free or had improvement (group I), while the remaining 22 patients had persistent dyspepsia (group II). Gallbladder volume change and ejection fraction were analyzed and compared among the three groups. RESULTS In group I, there were significant decreases in gallbladder volumes 5-25 min after gastric distension, compared to fasting volumes. Compared to normal volunteers and group II, group I had significantly decreased gallbladder volumes 10-20 min after drinking 500 mL of normal saline and 10 to 50 min after eating fatty meal. CONCLUSION Our results support the hypothesis that increased gallbladder contraction after gastric distension or fatty meal may be related to dyspeptic symptoms in uncomplicated gallstone disease. These findings may be useful in differentiating functional dyspepsia from gallstone dyspepsia, patients with the latter disease may benefit from laparoscopic cholecystectomy.

[1]  A. Hughes,et al.  Symptomatic and silent gall stones in the community. , 1991, Gut.

[2]  A. Hofmann,et al.  Nocturnal gallbladder storage and emptying in gallstone patients and healthy subjects. , 1978, Gastroenterology.

[3]  K. Gwee,et al.  The pattern of functional and organic disorders in an Asian gastroenterological clinic , 1994, Journal of gastroenterology and hepatology.

[4]  G. Fried,et al.  Correlation between Release of Cholecystokinin and Contraction of the Gallbladder in Patients with Gallstones , 1982, Annals of surgery.

[5]  E. Shaffer,et al.  Abnormal gallbladder emptying in a subgroup of patients with gallstones. , 1985, Gastroenterology.

[6]  N. West,et al.  Is cholecystectomy effective treatment for symptomatic gallstones? Clinical outcome after long-term follow-up. , 1998, Annals of the Royal College of Surgeons of England.

[7]  H. Troidl,et al.  [Dyspepsia and food intolerance in symptomatic gallstone disease. Does cholecystectomy help?]. , 1991, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[8]  K. V. van Erpecum,et al.  Fasting gallbladder volume, postprandial emptying and cholecystokinin release in gallstone patients and normal subjects. , 1992, Journal of hepatology.

[9]  J. Utsunomiya,et al.  Gallbladder Dynamics and Plasma Cholecystokinin Responses After Meals, Oral Water, or Sham Feeding in Healthy Subjects , 1988, The American journal of the medical sciences.

[10]  J. Rehfeld,et al.  Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones. , 1999, Scandinavian journal of gastroenterology.

[11]  M. Fried,et al.  Role of nutrient fat and cholecystokinin in regulation of gallbladder emptying in man , 1995, Digestive Diseases and Sciences.

[12]  P. Howard,et al.  Gall bladder emptying patterns in response to a normal meal in healthy subjects and patients with gall stones: ultrasound study. , 1991, Gut.

[13]  E. Ros,et al.  Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery. , 1987, Gut.

[14]  N. Talley.  Gallstones and upper abdominal discomfort. Innocent bystander or a cause of dyspepsia? , 1995, Journal of clinical gastroenterology.

[15]  D. Spiegelhalter,et al.  A database on dyspepsia. , 1994, Gut.

[16]  W. Hopman,et al.  A computerized method for rapid quantification of gallbladder volume from real-time sonograms. , 1985, Radiology.

[17]  P. Pikkarainen,et al.  Etiology of dyspepsia: four hundred unselected consecutive patients in general practice. , 1995, Scandinavian journal of gastroenterology.

[18]  M. Camilleri,et al.  Definition and investigation of dyspepsia , 1989, Digestive Diseases and Sciences.

[19]  R. Fisher,et al.  Abnormal gallbladder emptying in patients with gallstones , 1982, Digestive Diseases and Sciences.

[20]  E. Shaffer,et al.  Quantitative cholescintigraphy: assessment of gallbladder filling and emptying and duodenogastric reflux. , 1980, Gastroenterology.

[21]  A. Egbert.  Gallstone symptoms. Myth and reality. , 1991, Postgraduate medicine.

[22]  O H Gilja,et al.  Imaging studies in dyspepsia. , 1998, The European journal of surgery. Supplement. : = Acta chirurgica. Supplement.

[23]  H. T. Debas,et al.  Evidence For a Pyloro‐Cholecystic Reflex for Gallbladder Contraction , 1979, Annals of surgery.

[24]  J. Ag.  Cholecystectomy and gallstone dyspepsia. Clinical and physiological study of a symptom complex. , 1975 .

[25]  R. Lefering,et al.  Long‐term results after laparoscopic cholecystectomy , 1995, The British journal of surgery.