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[Evaluation of gallbladder kinetics using a very simple sonographic method].

Both cholecystographic and sonographic analysis of the contraction of the gallbladder showed good correlation between relative decrease of gallbladder width and relative decrease of the area or volume (R = 0.86, p less than 0.001, n = 14, R = 0.80, p less than 0.05, n = 7 respectively). Therefore, we used the relative decrease in the width of the gallbladder to predict the relative decrease in volume. The volume was calculated using a formula given in the literature, after determination of the length, width and depth, using realtime sonography. Correlation between the calculated relative decrease of volume of the gallbladder and the predicted value, was good (R = 0.90, p less than 0.01, n = 8). The relative decrease in the width of the gallbladder in the with of the gallbladder! Can therefore represent the Contraction of the whole gallbladder. Due to its simple method of determination it can be recommended as a complement to sonography of the gallbladder. First of all, however, it will be necessary to conduct a study in a relatively large number of healthy volunteers to obtain the reference values.

Adult↗

nm23-H1 protein immunoreactivity in cancers of the gallbladder, extrahepatic bile ducts and ampulla of Vater.

Immunohistochemical expression of the nm23-H1 protein was investigated in carcinoma of the gallbladder (n = 13), common bile duct (n = 5) and ampulla of Vater (n = 7) using the monoclonal antibody, NM 301 (Molecular Oncology Inc.). This was compared with cases of chronic cholecystitis (n = 11) and preneoplastic lesions of the gallbladder (n = 4) and ampulla (n = 3). Absent or weak nm23-H1 protein immunoreactivity was found in most (67%) of the poorly differentiated adenocarcinomas of the gallbladder and in half of the cases of moderately differentiated adenocarcinomas. The difference in nm23-H1 protein immunostaining between gallbladder carcinoma and chronic cholecystitis was statistically significant (p = 0.0022; X2 test). Significant correlation was found between prolonged patient survival periods and nm23-H1 immunoreactivity in gallbladder carcinomas (R = 0.687, p = 0.01, linear regression analysis; r = 0.652, p = 0.016, Spearman's rank test). Most of the gallbladder dysplasias and adenomas had no reduction in nm23-H1 protein immunoreactivity. All common bile duct carcinomas, most (67%) ampullary carcinomas in situ and some (43%) ampullary carcinomas had moderate to strong nm23-H1 immunostaining. In summary, low nm23-H1 protein immunoreactivity was found more frequently in gallbladder carcinomas than in chronic cholecystitis and was associated with reduced patient survival. The differences in nm23-H1 protein immunoreactivity in common bile duct and ampullary carcinomas suggest that these tumors have a different molecular origin to gallbladder cancers.

Adenocarcinoma↗

Pain patterns after distension of the gallbladder in patients with acute cholecystitis.

BACKGROUND: Visceral pain is characterized by poor pain localization and a referred or radiating pain pattern. Its clinical importance in the abdomen is stressed by the finding that about one-third of patients still complain of abdominal pain after cholecystectomy. A better understanding of symptoms arising from the gallbladder and the underlying pathophysiology is therefore desirable. The aim of the present study was consequently primarily to characterize the symptom patterns after distension of the gallbladder. Secondary aims were to describe the pressure-volume relation in the gallbladder and the cystic duct opening pressure. METHODS: Twelve patients (nine women, three men) treated with cholecystostomy for acute cholecystitis were investigated. Simultaneous cholescintigraphy and measurement of changes in intraluminal gallbladder pressure after injections of saline through a gallbladder catheter were performed. After each injection of saline the localization of pain and the presence of nausea and vomiting were registered. The injections continued until the patient felt abdominal pain necessitating cessation of the investigation or until the cystic duct opened (visualized on cholescintigraphy). RESULTS: Distension of the gallbladder caused pain in 10 of the 12 patients. In 70% the pain was localized under the right costal margin or in the epigastrium. No mathematical formula could describe the pressure-volume relation in the gallbladder. The cystic duct opening pressure varied between 3 and 44 mmHg. CONCLUSIONS: Pain caused by increased gallbladder pressure is localized mostly, but not always, under the right curvature and in the epigastrium. A substantial variation in cystic duct opening pressure was found.

Acute Disease↗

Ultrasonographic evaluation of fatty meal stimulated gallbladder contraction in the diagnosis of biliary dyskinesia in children.

AIM: Biliary dyskinesia (BD) is characterized by symptoms of biliary disease, no evidence of gallstones on ultrasonography (USG), and diminished gallbladder ejection fraction. The diagnosis is based on findings of abnormal gallbladder ejection fraction diagnosed by hepatobiliary scintigraphy before and after stimulation of gallbladder contraction with cholecystokinin (CCK). We used an easier diagnostic technique defined as ultrasonographic evaluation of fatty meal stimulated gallbladder contraction, employing USG with the diagnosis of biliary dyskinesia in children. The study was conducted by USG to investigate the volume and contractility of the gallbladder (GB) in fasting conditions and 45 min after a standardized fatty meal (SFM) in normal children and in a group of BD patients, and to compare the diagnostic value of this test with scintigraphy and to evaluate its use as a new method in the diagnostic algorithm of BD. METHODS: We assessed the volume changes and contractility of the GB in response to SFM by USG in 14 patients with BD diagnosed by cholecystokinin stimulated hepatobiliary scintigraphy (CCKs-HBS); and compared them with 14 control patients matched for age and gender before cholecystectomy. After an overnight fasting, GB volume was measured by USG then the GB volume was again measured after the SFM ingestion. Using USG, length, width and height of GB were measured, and volume of the GB was calculated using the 'Dodds' formula. These volume measurements were used to calculate the percentage of gallbladder emptying (ejection fraction). Fasting, after SFM and EF values comparisons between groups were done with student's t-test. RESULTS: No statistically significant difference of fasting GB volumes were demonstrated between BD and control groups (14.1+/-6.7 cm3 and 13.4+/-4.0 cm3 respectively). GB volumes of the BD group after SFM were significantly greater than in healthy controls (13.1+/-1.8 cm3 and 3.4+/-0.9 cm3 respectively, P<0.0005). The calculated percentage of gallbladder contraction (ejection fraction) was found to be lower in BD patients than in healthy controls (7.1%+/-1.8% and 73.8%+/-6.4%, respectively, P<0.0005). CONCLUSION: Ultrasonographic evaluation of fatty meal stimulated gallbladder contraction provides relatively reliable and reproducible results. Thus it can be used for scanning in patients with biliary symptoms as a prior modality to CCK-HBS since it is a relatively easier, safer and available method with which to make a definitive diagnosis of BD. The patients with symptoms of biliary disease and no evidence of gallstones on USG should be evaluated by the method proposed in this study before the routine laboratory and radiologic tests.

Adolescent↗

Increased gallbladder-related mortality among Hispanics: does education play a role?

OBJECTIVE: Hispanics, particularly Mexican Americans, are known to have a higher incidence of mortalities whose underlying cause is a gallbladder-related disorder. These analyses evaluate the role of educational attainment in the differential mortality experiences of these populations. METHODS: US mortality data for 1989-1991 were examined to determine ethnically-specific death rates using 'any mention' of the disease on the death certificate. RESULTS: Age-adjusted multiple cause mortality was found to be higher for all gallbladder-related disorders among Hispanics, particularly Mexican Americans. Mortality due to gallbladder cancer, gallstones and 'other gallbladder diseases' were found to be inversely proportional to educational attainment in all ethnic groups. When both age and education were used to adjust mortality, the gallstone and other gallbladder disease mortality among Hispanics was non-significantly higher than white, non-Hispanics. However, mortality due to gallbladder cancer remained significantly higher among Hispanics. CONCLUSION: Gallbladder cancer mortality is elevated in Hispanic populations, especially Mexican Americans, independent of educational attainment. However, increased mortality associated with gallstones or other gallbladder diseases among Hispanics may be partially due to differences in factors associated with educational attainment. Research and public health efforts to address these educational-related factors may improve this mortality pattern among Hispanics.

Adult↗

The effect of the degree of histologic inflammation on gallbladder perforation during laparoscopic cholecystectomy.

PURPOSE: Laparoscopic cholecystectomy (LC) is the gold standard operation for the treatment of symptomatic gallstones. Intraoperative gallbladder perforation is a common complication encountered during the surgery. The purpose of this study was to identify the effects of inflammation on gallbladder perforation during LC. METHODS: Between July 1997 and March 2003, 509 patients underwent LC for symptomatic gallstone disease at the Department of Surgery at Vakif Gureba Training Hospital. Data were collected retrospectively. Patients with and without gallbladder perforation were compared in terms of gender, age, anatomic difficulty, experience of the surgeon, omental and other organ adhesions to the gallbladder, and the findings of inflammation on the resected gallbladder. RESULTS: Intraoperative gallbladder perforation occurred in 85 patients (16.6%). Although no differences were found between the perforated and nonperforated groups regarding age, gender, and chronic inflammation on the resected gallbladder, there were significant differences in terms of acute inflammation, anatomical difficulty, experience of the surgeon, and omental and organ adhesions. CONCLUSION: Acute inflammation, degree of anatomic difficulty, the experience of the surgeon, and omental or other organ adhesions were associated with gallbladder perforation during LC.

Adult↗

Increased prevalence of clinical gallbladder disease in subjects with non-insulin-dependent diabetes mellitus.

The association between non-insulin-dependent diabetes mellitus (NIDDM) and the prevalence of gallbladder disease remains controversial. The authors investigated this association in 1,250 men and 1,656 women from the San Antonio Heart Study (1984-1988) a population-based study of diabetes and cardiovascular disease. A total of 68% of the subjects were Mexican American, a population at high risk for both gallbladder disease and NIDDM. Gallbladder disease was assessed by self-report, and the prevalence of diabetes was determined using National Diabetes Data Group criteria. NIDDM was significantly associated with gallbladder disease in Mexican-American men and women and in non-Hispanic white women. After adjustment for age, body mass index, ratio of waist-to-hip circumference, and ethnicity, using multiple logistic regression, the odds of gallbladder disease in women was 1.6 times higher if NIDDM was present (odds ratio = 1.60, 95% confidence interval 1.08-2.37). Mexican-American women also had a significantly increased prevalence of gallbladder disease relative to non-Hispanic white women (odds ratio = 2.21, 95% confidence interval 1.50-3.28). In nondiabetic women, fasting insulin was significantly related to prevalence of gallbladder disease in univariate analyses, but not in multivariate analyses. The authors conclude that women with diabetes have an increased prevalence of gallbladder disease relative to nondiabetic women and that this association is not explained by the greater adiposity or unfavorable body fat distribution of the diabetic subjects.

Adult↗

Correlation between gallbladder size and release of cholecystokinin after oral magnesium sulfate in man.

In order to determine the effect of oral magnesium sulfate on gallbladder contraction and release of cholecystokinin (CCK) in man, magnesium sulfate (25 g in 100 ml distilled water) was given by mouth to five fasting adult male volunteers. Plasma samples were collected for measurement of CCK by a specific radioimmunoassay. Gallbladder volumes were determined from sonograms obtained from a phased-array real-time ultrasound scanner. Basal concentrations of CCK (82.2 +/- 10.1 pg/ml) increased significantly at 20 minutes after oral magnesium sulfate (113.8 +/- 7.1 pg/ml), and reached a maximal value at 50 minutes (150.0 +/- 42.0 pg/ml). The mean basal volume of the gallbladder was 30.8 +/- 5.3 cm(3) and maximum reduction of gallbladder volume (to one third of original) was achieved at 50 minutes after ingestion of magnesium sulfate. Linear regression analysis showed a close correlation (r = -0.9337) between plasma concentrations of CCK and gallbladder size in response to magnesium sulfate. Oral magnesium sulfate also caused a significant increase in serum gastrin (from basal of 51.4 +/- 9.9 pg/ml to 69.8 +/- 15.5 pg/ml at 5 min); there was no significant correlation between gastrin release and gallbladder contraction. This study provides direct evidence that the mechanism of magnesium sulfate-stimulated gallbladder contraction occurs through the release of CCK, and shows a close correlation between CCK release and contraction of the gallbladder.

Adult↗

The effects of Lipomul, CCK, and TRH on gallbladder emptying.

Tc-99m IDA compounds have been used in the quantitative analysis of motor function of the gallbladder. However, stimuli to provoke emptying have been variable and frequently nonphysiologic. To determine the utility and dependability of provocative agents for gallbladder emptying, we studied the effects of Lipomul, CCK, and TRH after the intravenous administration of Tc-99m disofenin. Computer processing of region-of-interest over the gallbladder permitted time/activity analysis of each study and computation of the ejection fraction (EF). Results showed that Lipomul consistently produced an effect on gallbladder emptying (EF 16-42%). CCK, while more dramatic in response, was less predictable (EF 8-100%). TRH favored accumulation of activity and did not cause gallbladder emptying. The combination of CCK and TRH decreased the rate of gallbladder emptying produced by CCK alone. We conclude that the availability, low cost, and dependable effect on gallbladder emptying make Lipomul the gallbladder stimulant of choice for clinical use.

Cholecystokinin↗

Evaluation of gallbladder volume and motility in non-insulin-dependent diabetes mellitus patients using real-time ultrasonography.

AIMS: The prevalence of cholelithiasis is 2 to 3 times higher in patients with diabetes mellitus than in the normal population, especially in a group of patients with non-insulin-dependent diabetes mellitus (NIDDM). We investigated the pathogenesis of this increased prevalence by ultrasonography with a brief comparison of demographic features. MATERIALS AND METHODS: The study group was consisted of NIDDM patients (41 males and 47 females, mean age 53.5 +/- 11 years), and the control group included healthy volunteers (33 males and 34 females, mean age 50.3 +/- 18 years). All patients were investigated after 12 hours of fasting and 30 minutes after a standard test meal. Pre-meal and post-meal gallbladder volumes were used for calculation of the ejection fraction of the gallbladder and fasting gallbladder volume. RESULTS: In the study group, there was no correlation between the fasting gallbladder volume and age, parity, and body mass index. However, fasting gallbladder volume and duration of diabetes mellitus showed significant correlation (r = 0.212, P < 0.05). The mean ejection fraction of gallbladders in the study group was 48.48%, whereas that of the control group was 56.32%. There was a significant reduction of ejection fraction in the study group (P = 0.003). CONCLUSION: Our study indicated that there were an increased fasting gallbladder volume and impaired ejection fraction in NIDDM patients. This may be the initiator of bile stasis in the gallbladder and subsequent cholesterol crystal and stone formation.

Adult↗

Organochlorine pesticides in carcinoma of the gallbladder: a case-control study.

Carcinoma of the gallbladder is the third most common malignancy of the gastrointestinal tract in the Eastern Uttar Pradesh and Western Bihar regions of India. The main source of drinking water in this region is the river Ganges, which is heavily polluted with agricultural pesticides. Organochlorine pesticides were estimated in bile by gas liquid chromatography in 60 patients (30 carcinoma of the gallbladder and 30 cholelithiasis) to observe its association with aetiopathogenesis of carcinoma of the gallbladder. The mean biliary concentration of benzene hexachloride (BHC) was found to be significantly higher in carcinoma of the gallbladder (0.0471 ppm) than in cholelithiasis (0.0352 ppm) (P < 0.04). The mean biliary concentration of dichlorodiphenyltrichloroethane (DDT) was also significantly higher in carcinoma of the gallbladder (0.418 ppm) than in cholelithiasis (0.0103 ppm) (P < 0.03). Biliary aldrin and endosulfan concentrations were higher in carcinoma of the gallbladder (0.0008 and 0.00132 ppm) than in cholelithiasis (0.0005 and 0.0126 ppm) but the difference was statistically not significant (P < 0.06 and P < 0.9). The levels of pesticides in blood did not show significant differences in either carcinoma of the gallbladder or cholelithiasis. Significantly high biliary BHC and DDT concentrations suggest that these pesticides might be associated with gallbladder carcinogenesi.

Agriculture↗

Gallbladder motility before and after Billroth II gastric resection.

The aim of this study was to determine the effect of Billroth II gastric resection (BII) without vagotomy on gallbladder contraction in response to meal and CCK-OP infusion. Fourteen duodenal ulcer patients were studied before surgery and six months postoperatively. Gallbladder volume was measured by real-time ultrasonography. After surgery, there was a significant increase in fasting gallbladder volume (P < 0.05). Postprandial gallbladder emptying was not significantly affected by gastrectomy apart from a trend towards a shorter t1/2 and a larger ejection volume. In addition, postoperative gallbladder relaxation was more pronounced at time 120 min. In response to cholecystokinin-octapeptide (CCK-OP) infusion, there was a significant decrease of t1/2 after BII and a prolonged contraction with a significantly reduced gallbladder volume. Our data show that the gallbladder response both to meal and CCK-OP infusion is modified after BII and a larger postoperative gallbladder volume may play a role in the pathogenesis of gallstone disease after gastric surgery.

Adult↗

Role of CCK in gallbladder function.

Cholecystokinin may play a role in regulation of interdigestive motility, but this still remains to be investigated. CCK constitutes the major hormonal stimulus for postprandial gallbladder emptying. CCK exerts its contractile effects mainly through interaction directly with receptors on the gallbladder smooth muscle cells in the muscle layer, but also through interaction with cholinergic nerves extrinsic and/or intrinsic in nature. Furthermore, CCK can enhance ongoing nicotinic ganglionic transmission occurring in the serosal layer by release of acetylcholine. CCK interaction with the gallbladder smooth muscle CCKA receptor was studied in further detail. CCK contracts strips of gallbladder muscle in a concentration-dependent way with a potency in the nanomolar range in all tested species. The potency is 1,000-fold better than that of gastrin; thus, the receptor is of type CCKA. CCK binding to this receptor is specific and of high affinity, 1,000-fold better than that of gastrin with no differences between the tested species including bovine, porcine, and human. Also, CCK binding affinity was independent of age, gender, or weight of the person and pathology of the human gallbladder. The biochemistry of the CCKA receptor varies between the tested species (bovine and human). Both CCKA receptors are heavily glycosylated, but of different size and carbohydrate content. The bovine CCKA receptor is of apparent size M(r) = 70-85 kD with N-linked complex carbohydrates and sialic acids. The human CCKA receptor is of M(r) = 85-95 kD, with N-linked complex carbohydrates, but no sialic acids. They both have a protein core of apparent size M(r) = 43 kD, with almost identically sized fragments after enzymatic cleavage. Probably the protein cores contain the receptor binding region, which seems well preserved between species. CCK and the CCKA gallbladder muscularis receptor are main regulators of postprandial gallbladder emptying. The biochemistry of the CCKA gallbladder smooth muscle receptor is in accord with newly generated data of purification and cloning of the rat pancreatic CCKA receptor.

Amino Acid Sequence↗

Expression of human telomerase catalytic protein in gallbladder carcinogenesis.

BACKGROUND: Telomerase catalytic subunit (hTERT) gene re-expression is a rate limiting step for the activity of telomerase, a key enzyme implicated in cellular immortalisation and transformation. AIMS: To determine the potential role of hTERT protein in gallbladder carcinogenesis. MATERIAL/METHODS: hTERT protein was analysed by means of immunohistochemistry in 89 gallbladder tissue samples: 16 normal epithelia, 14 reactive hyperplasias, 15 low grade dysplasias, 16 high grade dysplasias, and 28 adenocarcinomas. At least 200 nuclei were assessed for each slide and the mean number of positive signals for each nucleus was expressed as the hTERT index. RESULTS: The mean hTERT index increased progressively with the degree of gallbladder epithelial abnormalities: from 0.03 in normal epithelia, 0.04 in hyperplastic epithelia, 0.25 in low grade dysplasia, 0.82 in high grade dysplasia, to 0.93 in adenocarcinoma. Statistical analysis revealed that three different groups of gallbladder epithelial changes can be distinguished according to the number of hTERT signals for each nucleus: (1) normal and regenerative gallbladder epithelium, (2) low grade dysplasia, and (3) high grade dysplasia and adenocarcinoma (p < 0.001). CONCLUSIONS: The occasional presence of hTERT protein in normal and regenerative gallbladder mucosa reflects their regenerative capacity. Nevertheless, significantly higher hTERT indices in low and high grade dysplastic epithelia and in gallbladder adenocarcinomas are probably a consequence of hTERT re-expression--an early event in the multistep process of gallbladder carcinogenesis.

Adenocarcinoma↗

Direct determination of the contractility of the guinea pig gallbladder: a new in vivo model.

In vivo methods to study gallbladder contractility either equate gallbladder emptying with contraction or have relied on changes in gallbladder intravesicular pressure to reflect active transmural tension. We therefore devised an animal model in which the contractile force of the intact gallbladder is measured directly while the blood and neural supply remains uncompromised. Under general anesthesia one pole of the guinea pig gallbladder is anchored to the sternum and the other connected to a force displacement transducer. Any contraction--relaxation between these two points is recorded. This model was validated by measuring gallbladder response to both neuronal and humoral stimulation. Nerve stimulation was accomplished by means of two silver collar electrodes placed in contact with the cystic duct. With nerve stimulation, a frequency (0.5-10 Hz) or amplitude (1-10 V) dependent contraction occurred. Intravenous bethanechol (10 X 10(4) ng . kg-1 . h-1) and cholecystokinin (3 X 10(4) ng . kg-1 . h-1) both induced dose-dependent gallbladder contraction. This model should prove useful in assessing the physiologic control of gallbladder contraction.

Animals↗

Imaging of gallbladder carcinoma.

Although carcinoma of the gallbladder has a low overall prevalence, it is the most common malignant tumor of the biliary tract. Retrospectively, 59 cases of histologically proved gallbladder carcinoma were reviewed. The series consisted of 42 women and 17 men, ranging in age from 35 to 86 years. Clinical manifestations of gallbladder carcinoma include right upper quadrant pain, anorexia, weight loss, and jaundice. Radiologic findings included focal or diffuse thickening of the gallbladder wall (49%), a mass in the gallbladder fossa (37%), and an intraluminal mass (14%). Associated findings were cholelithiasis (64%), biliary duct dilatation (38%), invasion of the adjacent structures (67%), distant metastases other than those of the liver (3%), and porcelain gallbladder (4%). The histologic diagnoses were adenocarcinoma (90%) and squamous cell carcinoma (10%). Differential diagnoses include all conditions in which the gallbladder wall appears thickened. A general awareness of the radiologic features of gallbladder carcinoma enhances preoperative diagnoses.

Adult↗

The pearl necklace sign: an imaging sign of adenomyomatosis of the gallbladder at MR cholangiopancreatography.

PURPOSE: To evaluate the demonstration of the pearl necklace sign at magnetic resonance (MR) cholangiopancreatography (MRCP) in patients with proven adenomyomatosis and carcinoma of the gallbladder. MATERIALS AND METHODS: MRCP findings and those of a combination of unenhanced and arterial phase computed tomography (CT) and arterial phase MR imaging were retrospectively compared in 29 patients who were pathologically proven to have adenomyomatosis of the gallbladder and in 18 patients with pathologically proven gallbladder carcinoma. Receiver operating characteristic (ROC) analysis was used with a five-point confidence scale. The relative sensitivity, specificity, and accuracy of each imaging modality were also calculated. The pearl necklace sign was defined on MRCP images as small round foci, with the same markedly high signal intensity as bile, within the thickened wall of the gallbladder. RESULTS: The mean area under the ROC curve of MRCP alone and that of the combination of MRCP and arterial phase MR imaging was significantly higher than that of combined CT (unenhanced and arterial phase) and arterial phase MR imaging alone (P <.01). The relative sensitivities in the diagnosis of adenomyomatosis of the gallbladder were 24% for the combined CT, 29% for arterial phase MR imaging, 62% for MRCP, and 57% for the combination of MRCP and arterial phase MR imaging. The mean relative sensitivity, specificity, and accuracy of the pearl necklace sign on MRCP images were 62%, 92%, and 74%, respectively. In eight (28%) of 29 patients with adenomyomatosis of the gallbladder, the pearl necklace sign was not identified by all three readers on the MRCP images. CONCLUSION: The pearl necklace sign, which indicates the presence of Rokitansky-Aschoff sinuses within the thickened gallbladder wall, was specifically detected at MRCP for adenomyomatosis of the gallbladder.

Adenomyoma↗

Effects of peptide YY on gallbladder motility.

The effects of peptide YY (PYY) on cholecystokinin-stimulated gallbladder contraction were investigated in the prairie dog model. Twelve animals underwent laparotomy with catheter placement into the gallbladder and common bile duct (vent). The gallbladder was continuously perfused with [14C]polyethylene glycol-labeled lactated Ringer at 0.03 ml/min, and vent effluent was collected at 2.5-min intervals. All animals received 20 min of intravenous infusion of cholecystokinin octapeptide (CCK-OP), 2.5 ng X kg-1 X min-1, immediately followed by 60-min infusions of either lactated Ringer (LR) or synthetic PYY, 10 or 50 ng X kg-1 X min-1. When LR was infused after CCK-OP, gallbladder filling increased by 15.4 +/- 10.5% with minimal changes in gallbladder pressure. Infusion of PYY10 resulted in a significant increase in gallbladder volume (P less than 0.05) and filling (P less than 0.01) with a significant decrease in intragallbladder pressure (P less than 0.05). Similar findings were noted with PYY50. These data indicate that synthetic PYY significantly augments gallbladder filling after CCK-OP-stimulated gallbladder contraction. These findings, coupled with the observation that PYY inhibits pancreatic secretion, suggest that this peptide may be the "anti-CCK" hormone and may have an important role in regulating biliary activity postprandially.

Animals↗