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PubMedDate not supplied

Epidemiology and molecular pathology of gallbladder cancer.

Gallbladder cancer is usually associated with gallstone disease, late diagnosis, unsatisfactory treatment, and poor prognosis. We report here the worldwide geographical distribution of gallbladder cancer, review the main etiologic hypotheses, and provide some comments on perspectives for prevention. The highest incidence rate of gallbladder cancer is found among populations of the Andean area, North American Indians, and Mexican Americans. Gallbladder cancer is up to three times higher among women than men in all populations. The highest incidence rates in Europe are found in Poland, the Czech Republic, and Slovakia. Incidence rates in other regions of the world are relatively low. The highest mortality rates are also reported from South America, 3.5-15.5 per 100,000 among Chilean Mapuche Indians, Bolivians, and Chilean Hispanics. Intermediate rates, 3.7 to 9.1 per 100,000, are reported from Peru, Ecuador, Colombia, and Brazil. Mortality rates are low in North America, with the exception of high rates among American Indians in New Mexico (11.3 per 100,000) and among Mexican Americans. The main associated risk factors identified so far include cholelithiasis (especially untreated chronic symptomatic gallstones), obesity, reproductive factors, chronic infections of the gallbladder, and environmental exposure to specific chemicals. These suspected factors likely represent promoters of carcinogenesis. The main limitations of epidemiologic studies on gallbladder cancer are the small sample sizes and specific problems in quantifying exposure to putative risk factors. The natural history of gallbladder disease should be characterized to support the allocation of more resources for early treatment of symptomatic gallbladder disease in high-risk populations. Secondary prevention of gallbladder cancer could be effective if supported by cost-effective studies of prophylactic cholecystectomy among asymptomatic gallstone patients in high-risk areas.

Cholelithiasis↗

PubMed2005

Evaluation of gallbladder motility in patients with irritable bowel syndrome.

BACKGROUND: Abnormalities involving smooth muscle function in different systems of the body have been reported in irritable bowel syndrome (IBS). There are a few studies on gallbladder function in this disorder with conflicting results. OBJECTIVES: To investigate the motility of gallbladder in patients with IBS. PATIENTS AND METHODS: Forty-eight patients (15 male and 33 female) with IBS and 48 healthy volunteers (15 male and 33 female) were included into the study. Thirty-four patients (70.8%) had constipation predominant and 14 patients (29.2%) had diarrhoea predominant type of IBS. Fasting and postprandial gallbladder volumes were studied using real time ultrasonography and ejection fraction (EF) of gallbladder was calculated. RESULTS: While fasting gallbladder volume (FGV) was similar between IBS and control groups (18.0 +/- 4.0 ml vs. 17.8 +/- 4.9 ml, p >0.05), postprandial gallbladder volume (PGV) was lower in IBS group than in the control group (5.5 +/- 1.4 ml vs. 6.2 +/- 1.9 ml, p = 0.03). Accordingly, the mean EF of gallbladders was found to be higher in IBS group than in the control group (69.1% vs. 64.1%, p = 0.0001). There were no difference in FGV, PGV and EF of gallbladders between constipation predominant and diarrhoea predominant IBS patients (p >0.05). CONCLUSION: The results of this study indicated that IBS patients have increased emptying of gallbladder compared to healthy subjects.

Adult↗

PubMed1998

[Gallbladder blunt trauma: comparison between radiologic and anatomo-surgical findings].

PURPOSE: To assess the diagnostic accuracy and the possible role of ultrasonography (US) and Computed Tomography (CT) in a small group of patients who had a blunt abdominal trauma involving the gallbladder. MATERIAL AND METHODS: We retrospectively reviewed the US and CT findings of five patients with surgically confirmed post-traumatic gallbladder injury. The whole series consisted of 196 consecutive patients submitted to laparotomy for blunt abdominal trauma in the past 7 years. The following US and CT findings were considered at least suggestive of a possible post-traumatic gallbladder injury: pericholecystic fluid collection, ill-defined wall margin, collapsed lumen, high intraluminal density. RESULTS: At surgery, the following findings were observed: gallbladder hematoma (1 case), acute colecystitis (1 cases), gallbladder tear (3 cases), gallbladder tear associated with post-traumatic hepatic injuries (2 cases), duodenal tear (2 cases), hemoperitoneum alone (2 cases), hemoperitoneum associated with choleperitoneum (1 case), choleperitoneum alone (1 case). The US and CT findings were pericholecystic fluid collections (4 cases), ill-defined gallbladder wall margins (3 cases), collapsed lumen with intraluminal high density (1 case) and free intraperitoneal fluid collections (4 cases). They were suggestive of a possible post-traumatic gallbladder injury in all the five patients. CONCLUSIONS: The radiologic findings of our five patients were suggestive of a gallbladder damage but did not permit to distinguish minor from major injuries, the latter requiring surgical treatment. US proves to be a useful screening tool which can also help timing surgery in these patients. CT confirmed the US suspicions and also permitted accurate assessment of associated post-traumatic injuries to the liver and duodenum. Nevertheless, the clinical presentation was the most important factor as to the therapeutic management of these blunt abdominal trauma patients.

Cholecystography↗

PubMed1999

Octreotide stimulates Ca++ secretion by the gallbladder: a risk factor for gallstones.

BACKGROUND: Gallstone formation during octreotide therapy has been linked to elevated levels of gallbladder bile Ca++, a well-known prolithogenic factor. Although the subcutaneous administration of octreotide raises gallbladder bile Ca++ in prairie dogs, the mechanism for this effect is unknown. Octreotide has been shown to increase gallbladder Na+ and water absorption in Ussing chamber studies. Given the known effects of octreotide on gallbladder ion transport, we hypothesized that octreotide may also promote gallstone formation by stimulating gallbladder Ca++ secretion, thereby raising the lumenal concentration of biliary Ca++. METHODS: After cholecystectomy, prairie dog gallbladders were mounted in Ussing chambers, and standard electrophysiologic parameters were recorded. Unidirectional fluxes of Ca++ and Na+ were measured before and after serosal exposure to 50 nmol/L octreotide. RESULTS: Under basal conditions normal prairie dog gallbladder absorbed mucosal Ca++. Serosal octreotide converted the gallbladder from a state of basal Ca++ absorption to one of net Ca++ secretion by stimulating serosa to mucosa Ca++ flux. As anticipated, octreotide increased net Na+ absorption by stimulating mucosa to serosa Na+ flux and decreased tissue conductance and short-circuit current significantly compared with baseline values. CONCLUSION: Fifty nanomoles per liter octreotide stimulated Ca++ secretion by gallbladder epithelium, a possible mechanism for increased biliary Ca++ in prairie dogs receiving subcutaneous injections. Ca++ secretion linked to octreotide therapy may induce gallstones by raising biliary levels of Ca++, a known prolithogenic factor.

Animals↗

PubMed1998

Clinical epidemiologic characteristics of 430 cases of gallbladder cancer.

OBJECTIVE: To make clear the incidence, clinical characteristics and possible regional difference of gallbladder cancer in China. METHODS: A total of 430 cases of gallbladder cancer from 28 hospitals between 1986-1996 were reviewed, according to a standard protocol called "the clinical epidemiological list of gallbladder cancer". RESULTS: The incidence of gallbladder cancer was higher in the females than in the males. There was significant difference in the incidence between the north and south of China, and between the mountain area and flatlands. Gallbladder cancer accounted for 1.6% of bile tract disease in the same period. Gallstones were found in about 50% of the cases of gallbladder cancer. The clinical symptoms included abdominal pain, ictus, etc. The major pathohistologic type was adenocarcinoma, and 58% of tumors were localized in the whole gallbladder. Metastasis occurred mainly along the biliary tract or directly to the bed of gallbladder and liver. Ultrasonography and CT were useful to diagnosis. The positive imaging diagnostic rate was higher in 1991-1996 than in 1986-1990 P < 0.05) [corrected]. The rate of operative resection was 100% for stage I and II disease, 75% for stage III and IV, and significantly lower for stage V (P < 0.05). The 3-year survival rate in patients with stage I or II disease was significantly higher than that in those with terminal cancer (P < 0.05). CONCLUSIONS: There is specific populational, time and regional difference in the distribution of gallbladder cancer. Ultrasonography and CT are the most important diagnostic methods. Early diagnosis and early radical resection are the key to increasing the 5-year survival rate.

Adenocarcinoma↗

PubMedDate not supplied

Gallbladder hematoma in a patient with hemophilia B, report of a case.

The authors report the case of a 49-year-old man, hematoma of the gallbladder associated with hemophilia B. The patient was diagnosed incidentally by abdominal computed tomography with a gallbladder tumor. Endoscopic retrograde cholangiopancreatography revealed negative gallbladder and angiography showed no obvious abnormality in the cystic artery. Magnetic resonance imaging showed a mass of mixed intensity on T2-weighted image and a mass of mixed intensity on the lining of the gallbladder wall. Hemorrhage in the gallbladder was thought to be most likely, however, the gallbladder tumor could not to be neglected. Cholecystectomy was performed on the patient and the pathological diagnosis was of a hemorrhage in the gallbladder. Hematoma of the gallbladder is a rare complication in patients with hemophilia B, however, it leads sometimes to a fatal course and magnetic resonance imaging is very useful to diagnose hemorrhage in the gallbladder.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed2000

Clinical and ultrasonographic findings of carcinoma of gallbladder in Indian patients.

OBJECTIVE: To determine the clinical and ultrasound appearances of carcinoma gallbladder in Indian patients. METHODS: The study included all patients suspected to have gallbladder malignancy, attending the gastroenterology department from January 1989 to February 1997. These patients underwent ultrasonographic examination with a grey scale sector scanner (Aloka SSD-630) with a 3.5 MHz transducer after an overnight fast. Histological confirmation was done at surgery, by US guided fine needle aspiration cytology or by direct biopsy/aspiration of the palpable mass. RESULTS: There were a total of 92 cases of cytologically and histologically proven carcinoma of gallbladder. A distinct female preponderance was seen with a male:female ratio of 1:3.6. The mean +/- SD age was 47.9 +/- 19.6 years (range 25-75 years). The histological confirmation was done at surgery in 10% of patients, by US guided fine needle aspiration cytology in 50 cases (54%) or by direct biopsy/aspiration of the palpable mass in 33 (36%) of cases. Pain in the right hypochondrium was the commonest presenting symptom (91%) followed by anorexia (88%) and weight loss (67%). Surgical obstructive jaundice was observed in 54% cases while 10.9% presented with biliary sepsis. A mass of mixed echogenicity protruding in the lumen of the gallbladder was seen in the majority of cases (52.8%). Less commonly infiltration of the gallbladder wall (33.7%) or a mass replacing the gallbladder (14.1%) was encountered. Gallstones were associated in 57% of patients with gallbladder malignancy. The elevated stone sign and peripancreatic nodal spread were important clues for gallbladder malignancy. CONCLUSION: A high index of suspicion of gallbladder malignancy in elderly Indian female patients presenting with features of choletithiasis, and awareness of the ultrasound findings may lead to early diagnosis and radical resection of this highly lethal malignancy.

Adult↗

PubMed1999

[Correlation between gene expression of CCK-A receptor and gallbladder emptying in gallstone patients].

OBJECTIVE: To investigate the expression of CCK-A receptor and its relation with gallbladder hypomotility in patients with gallstone. METHODS: 20 patients with gallstone and 10 normal subjects were studied and gallbladder emptying function was measured by B ultrasonography. The other 8 patients without gallstone who died of accident were selected as controls for measuring mRNA expression of CCK-A receptor of gallbladder; RT-PCR was used to explore gene expression of CCK-A receptor of gallbladder. RESULTS: The gallbladder motility was significantly impaired in gallstone patients. The patients had lower mRNA expression of CCK-A receptor than control subjects (0.633 +/- 0.167 vs. 0.944 +/- 0.230, P < 0.01), and so did patients with impaired gallbladder motility then those with normal motility (0.544 +/- 0.124 vs. 0.768 +/- 0.131, P < 0.05). Furthermore, the change of expression of CCK-A receptors was markedly correlated with gallbladder emptying (r = 0.925, P < 0.01). CONCLUSIONS: mRNA expression of CCK-A receptor in gallstone patients decreases, which was related to gallbladder hypomotility. The down-regulation of gene expression of CCK-A receptor plays an important role in gallbladder hypomotility in patients with gallstone.

Cholecystolithiasis↗

PubMedDate not supplied

Pre- and intraoperative evaluation of biliary system for successful laparoscopic cholecystectomy in porcelain gallbladder patients.

BACKGROUND/AIMS: A porcelain gallbladder is generally thought to be a relative contraindication for laparoscopic cholecystectomy because of the difficulties in grasping the calcified wall of the gallbladder with forceps and making a retraction which would create a good operation field. The aim of this study was to define the clinical criteria for safe laparoscopic cholecystectomy in the treatment of porcelain gallbladders. METHODOLOGY: Between January 1993 and December 2000, 4 patients with porcelain gallbladders underwent laparoscopic cholecystectomy in our department. The significant features of the biliary system which contributed to the surgical results were investigated in these patients. RESULTS: All 4 patients were successfully treated by means of laparoscopic cholecystectomy. The confluence of the cystic duct was clearly demonstrated on the preoperative cholangiogram in all patients. Furthermore, the neck portion of the gallbladder wall, revealed no calcification on the CT scans of 3 patients, although the whole wall of the gallbladder, including the neck portion, showed a circumferential calcification in the remaining patient. Laparoscopic exposure and dissection of the Calot's triangle was relatively easy to perform in the former and was difficult in the latter, and thus, an anterograde laparoscopic cholecystectomy was the procedure of choice. Intraoperative cholangiography clearly demonstrated the confluence of the cystic duct in all of the patients. CONCLUSIONS: Porcelain gallbladder is an indication for laparoscopic cholecystectomy, especially in cases of a patent cystic duct and an uncalcified wall in the neck portion of the gallbladder. Laparoscopic cholecystectomy might be an indication for selected patients with porcelain gallbladder when an uncalcified and patent cystic duct are evident in pre- and intraoperative cholangiograms.

Aged↗

PubMed2004

[Expression of P62 in gallbladder carcinoma tissues and its correlation with angiogenesis].

AIM: To detect the expressions of P62 and bFGF in human gallbladder carcinoma tissues and microvessel density(MVD) inside tumor, explore their correlation with each other, and their relationship with tumor's clinical pathological properties. METHODS: The expressions of P62 and bFGF in 41 cases of human gallbladder carcinoma tissues and 22 cases of chronic cholecystitis tissues were detected by SP immunohistochemical staining. The MVD was examined by SP immunohistochemical staining with anti CD34 mAb. RESULTS: The positive rates of P62 and bFGF in 41 cases of gallbladder carcinoma tissues (63.4% and 75.6%, respectively) were significantly higher than those in 22 cases of chronic cholecystitis tissues(P<0.01). The expression of P62 was associated with lymph node metastasis(P<0.05), but had no relation to tumor's histological grading and clinical stage. The expression of bFGF was correlated with tumor's histological grading and clinical stage, but not with lymph node metastasis. There was a positive correlation between P62 and bFGF expression rates(r = 0.512, P<0.01). Both proteins had no relation with patient's age, sex, tumor's type or cholelithiasis. MVD in the gallbladder carcinoma tissues was significant higher than that in the chronic cholecystitis tissues(P<0.01). The expression rates of P62 and bFGF were all correlated with MVD in gallbladder carcinoma tissues(P<0.05 and P<0.01), respectively. MVD in the gallbladder carcinoma tissues was associated with clinical stages and lymph node metastasis status (P<0.05, and P<0.01), respectively. but had no relation with patient's age, sex, tumor's type, histological grading and cholelithiasis. CONCLUSION: Expressions of P62 and bFGF were closely associated with angiogenesis in gallbladder carcinoma tissues, which may play a pivotal role in genesis and progression in gallbladder carcinoma. Expressions of P62 and bFGF may be helpful for diagnosis and therapy of gallbladder carcinoma.

Adult↗

PubMed2004

Protease-activating-receptor-2 is frequently expressed in papillary adenocarcinoma of the gallbladder.

Gallbladder carcinoma is one of the most devastating malignant tumors in Japan. An important risk factor for gallbladder carcinoma is pancreaticobiliary maljunction (PBM), which allows reciprocal reflux of bile and pancreatic juice. Protease-activated-receptor-2 (PAR-2), which is activated by trypsin, may be a key molecule in the process of carcinogenesis in the gallbladder epithelium. We investigated the relation between the expression of PAR-2 and clinicopathological findings in gallbladder carcinoma. The study group comprised 58 patients with gallbladder carcinoma. PAR-2 expression was identified by immunohistochemical staining of all tumor specimens. PAR-2 was expressed in cancerous gallbladder epithelium in 37 of 58 patients (64%). PAR-2 expression occurred more frequently in papillary adenocarcinoma (15 of 16 patients, 94%) than in non-papillary types (20 of 42 patients, 48%, p=0.005). Neither lymphatic invasion (p=0.03) nor venous invasion (p=0.009) occurred more frequently in gallbladder carcinoma with PAR-2 than in that without PAR-2. PAR-2 expression was not directly related to PBM (p=0.46). Papillary adenocarcinoma was associated with polypoid growth (p=0.01), PBM (p=0.01), decreased invasion to lymphatic (p=0.007) and venous vessels (p=0.005), lower T-factor (p<0.001), and lower clinical stage (p=0.02). PAR-2 is frequently expressed in papillary adenocarcinoma of the gallbladder. Trypsin may play an important role for carcinogenesis of the gallbladder through PAR-2 signaling.

Adenocarcinoma, Papillary↗

PubMed1992

Prevalence of gallbladder polyps among apparently healthy Japanese: ultrasonographic study.

The prevalence of gallbladder polyps was investigated in apparently healthy Japanese who underwent abdominal ultrasonography as part of their health screening examination. The polyps found were differentiated from gallstones, adenomas, or carcinomas as much as possible, and were considered to be cholesterol polyps. The prevalence of such gallbladder polyps was higher among males in every decade of age evaluated. The subjects with gallbladder polyps were more obese than the control group without gallbladder polyps, on abdominal ultrasonograms. The prevalence of gallbladder polyps rose in accordance with a rise in obesity index. At each range of obesity index, the prevalence of gallbladder polyps was higher among males. The prevalence of gallbladder polyps was highest among the middle-aged (40- and 50-yr-old) males, similar to the curve of the obesity index. In females, the obesity index increased with age, with no accompanying rise in the prevalence of gallbladder polyps. These data suggest that obesity contributes to the formation of cholesterol polyps of the gallbladder.

Adolescent↗

PubMed1991

The effect of capsaicin on gallbladder fluid absorption.

The role of the enteric nervous system of the gallbladder on mucosal water absorption was evaluated by intraluminal administration of capsaicin, a selective stimulant of afferent nerve endings. It has been postulated that the neural responses of the gallbladder are peptidergic and mediated by prostanoids. Anesthetized cats underwent gallbladder perfusion with a physiological buffer solution containing 14C polyethylene glycol as a nonabsorbable tracer to quantitate mucosal water absorption. Capsaicin was added to the perfusate and administered intraluminally at a rate of 5 mg/kg-1/hr-1 for 2 hr. One experiment on five cats was performed when capsaicin was administered and five control experiments were performed when only vehicle was added to the perfusate. Five experiments were performed when indomethacin was administered intravenously (5 mg/kg-1/hr-1) and buffer solution alone was used to perfuse the gallbladder, and five experiments were performed when capsaicin was added to the perfusate and indomethacin was administered intravenously. Additional experiments were performed when lidocaine was added to the perfusate and when lidocaine and capsaicin were administered simultaneously. Gallbladder absorption and perfusate and tissue prostaglandin E and 6 keto prostaglandin F1 alpha concentrations were evaluated. To determine whether capsaicin induced gallbladder inflammation, tissue myeloperoxidase concentrations were measured. Control feline gallbladders absorbed approximately 0.6 ml/hr. Indomethacin alone significantly decreased gallbladder absorption. Capsaicin administration increased gallbladder absorption to approximately 1.6 ml/hr, and this increase was significantly inhibited by indomethacin. (ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗

PubMed1990

[Primary carcinoma of the gallbladder].

Primary carcinoma of the gallbladder, while infrequent, is the most representative among the malignant neoplasms of the biliary tract. The diagnosis of carcinoma of the gallbladder was made in 22 out of 1252 operations performed for gallbladder disease (1.8%) since January 1980 through June 1988: only in 9% of the subjects a malignant tumor of the gallbladder was suspected preoperatively. In 21 cases the carcinoma was associated with chronic lithiasic cholecystitis. The 22 cases were assessed according to the classification proposed by Nevin. The operations performed were: 4 routine cholecystectomies (stages I and II) 4 cholecystectomies with lymphadenectomy (stages I and II); 4 cholecystectomies with lymphadenectomy and liver wedge resection of the bed of the gallbladder (stages II, III, IV, V); 7 explorative laparotomies and 3 gastrojejunal anastomoses (stage V). A complete follow-up was available for each of the 22 subjects: cumulative survival rates were calculated according to Kaplan-Meyer. The overall 5-year cumulative survival rate after operation was 19% for the whole group, whereas it reached 76% for the subgroup of 9 patients classified in stages I and II. This analysis reinforces the statement that surgical therapy can achieve excellent results if brought about before cancer overwhelms the muscular layer of the gallbladder wall. Thus, as the preoperative diagnosis of gallbladder carcinoma is extremely difficult and uncertain, any delay in performing cholecystectomy seems to be unwise in all those cases of chronic benign disease of the gallbladder (whether lithiasic in nature or not) that are suspected to be a major risk factor for cancer degeneration because of their frequent association with the carcinoma of the gallbladder.

Adult↗

PubMed1990

Gallbladder and gastrointestinal motility after hemorrhagic shock.

The alterations in fasting gallbladder and gastrointestinal motility during hemorrhagic shock were investigated. Eight opossums implanted with a gallbladder cannula, gastrointestinal bipolar electrodes, and a carotid catheter were subjected to hemorrhagic shock of 30 mm Hg for 60 minutes by the removal of arterial blood. Shed blood was reinfused after the shock period. Fasting gallbladder volume and gastrointestinal electrical activity were studied before, immediately after, and 24 hours after hemorrhagic shock. Control measurements demonstrated a slow-wave frequency maximal in the duodenum (18.1 +/- 1.1 waves/min), with a plateau in the proximal third of the small bowel, decreasing thereafter. The migrating motor complex (MMC) had a duration of 118 +/- 28 minutes. The average volume of the gallbladder before shock was 5.4 +/- 1.5 ml. Gallbladder volume fluctuated with the MMC, being maximal during phase I and minimal in phase III. The volume of blood removed to reduce mean arterial pressure to 30 mm Hg was 45 +/- 5 ml/kg. Immediately after the shock and blood reinfusion, slow-wave frequency decreased by 40% in the antrum and 25% in the small bowel. The MMC was of shorter duration (91 +/- 22 minutes; p less than 0.05), and gallbladder volume increased to 7.0 +/- 1.7 ml (p less than 0.05). Fluctuations in gallbladder volume during the MMC were absent. Twenty-four hours after shock, slow-wave frequency, MMC, and gallbladder volume had returned to normal and were not different from control measurements. Ischemic damage to the gastrointestinal tract is postulated as the cause of gallbladder dysfunction and altered intestinal motility after hemorrhagic shock.

Animals↗

PubMed1989

[The effect of age and sex on gallbladder motor dynamics. An echographic study].

Aging and female sex are major risk factors for cholesterol gallstones: in addition to hepatic secretion of lithogenic bile, decreased gallbladder contractility may play a role in such physiological conditions. This study was aimed at evaluating the effect of age and sex on gallbladder kinetics in healthy subjects. Gallbladder volume was measured on the US images of 157 fasting subjects using the sum-of-cylinders method. No significant difference was observed between males and females. On the contrary, age was shown to have a significant positive correlation with fasting gallbladder volume, particularly in males. In a second group of 63 healthy volunteers gallbladder volumes were evaluated both before and after a standard meal. The subjects were grouped according to age, and fasting gallbladder volume appeared to be significantly greater in the groups formed by older people. Gallbladder volumes were compared in younger groups (under 35), and gallbladder emptying resulted to be much more complete in males than in females. On the contrary, no significant difference was observed between males and females over 50--which suggests a possible role of sex- and age-related hormonal factors. The above changes in gallbladder function may facilitate bile stasis which might in turn contribute to the increased risk for cholesterol gallstones notoriously associated with advanced age and female sex.

Adolescent↗

PubMed1989

[Echographic study of gallbladder contraction: normal and pathologic aspects. Apropos of 115 patients].

The gallbladder volume was measured on abdominal ultrasonography in 115 patients consisting of three population groups, before and after ingestion of a fatty meal and/or intravenous administration of cholecystokinin. The variation in volume, estimated as a percentage, was used to assess gallbladder contraction. The first group, consisting of 40 normal individuals without gallstones or impaired gallbladder or hepatic function, can be considered to constitute a control group. In this population, gallbladder contraction exceeded 50% in every case. The second group consisted of 40 cases of acute cholecystitis, including 30 cases with acute gallstones and 10 cases of stone-free acute cholecystitis proven surgically (7 cases) or by guided aspiration (3 cases). Gallbladder contraction was less than 15% in every case. Lastly, a third group of 35 patients with uncomplicated gallstones discovered on routine ultrasonography, demonstrated gallbladder contraction of between 10 and 85%. In this last group, 12 patients with vague gastrointestinal symptoms and gallbladder contraction less than 15% were operated: the histological results demonstrated severe lesions of chronic gallstone cholecystitis. The authors believe that absent or weak gallbladder contraction after endogenous stimulation is a supplementary sign to be taken into consideration in a context suggestive of the diagnosis of acute stone-free cholecystitis and to suggest, in the presence of gastrointestinal symptoms not directly related to the gallbladder, the hypothesis of chronic gallstone cholecystitis.

Acute Disease↗

PubMed1989

Effects of atropine, proglumide, and somatostatin analogue (SMS 201-995) on bombesin-induced gallbladder contraction and CCK secretion in humans.

The effects of atropine, proglumide, and somatostatin analogue (SMS 201-995) on bombesin-induced gallbladder contraction and plasma cholecystokinin (CCK) secretion were investigated in healthy volunteers. The gallbladder size was measured by real-time ultrasonography and the plasma CCK levels by radioimmunoassay. Bombesin (5 micrograms/30 min infusion) induced gallbladder contractions that reduced the gallbladder area to 36.6 +/- 2.1% of the original area 45 min after bombesin infusion, and caused a significant increase of plasma CCK from a basal level of 10.3 +/- 1.8 pg/ml to a peak level of 42.9 +/- 8.9 pg/ml (p less than 0.01) at 20 min. Atropine (500 micrograms, im) inhibited significantly (p less than 0.01) the gallbladder contraction (maximum contractile rate, 78.7 +/- 6.4%) in response to bombesin without any change of plasma CCK secretion, whereas proglumide (800 mg/day for 3 days, per os) decreased slightly but not significantly the gallbladder contraction, and had no effect on plasma CCK secretion. On the other hand, SMS 201-995 (50 micrograms, sc) almost completely inhibited both bombesin-induced CCK secretion and gallbladder contraction (maximum contractile rate, 93.6 +/- 6.2%). These findings suggest that atropine inhibits bombesin-induced gallbladder contraction, not via suppression of CCK release, but probably by inhibiting cholinergic mechanisms, whereas somatostatin inhibits gallbladder contraction, at least in part, by the suppression of bombesin-stimulated CCK secretion.

Adult↗