Abstract
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 <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.
Article PDF
Similar content being viewed by others
References
LaMorte WW, Schoetz DJ, Birkett DH, Williams LF Jr: The role of the gallbladder in the pathogenesis of cholesterol gallstones. Gastroenterology 77:580–592, 1979
Holan KR, Holzbach RT, Hermann RE, Coopermann AM, Claffey WJ: Nucleation time: A key factor in the pathogenesis of cholesterol gallstone disease. Gastroenterology 72:611–617, 1979
Everson GT, McKinley C, Lawson M, Johnson M, Kern F Jr: Gallbladder function in the human female: Effect of the ovulatory cycle, pregnancy and contraceptive steroids. Gastroenterology 82:711–719, 1982
Roslyn JJ, Pitt HA, Mann LL, Ament ME, DenBesten L: Gallbladder disease in patients on long-term parenteral nutrition. Gastroenterology 84:148–154, 1983
Krejs GJ, Orci L, Conlon JM, Ravazzola M, Davis GR, Raskin P, Collins SM, McCarthy DM, Baetens D, Rubenstein A, Aldor TAM, Unger RH: Somatostatinoma syndrome. Biochemical, morphologic and clinical features. N Engl J Med 301:285–292, 1979
Thompson JC, Fried GM, Ogden WD, Fagan CJ, Inoue K, Wiener J, Watson LC: Correlation between release of cholecystokinin and contraction of the gallbladder in patients with gallstones. Ann Surg 195:670–675, 1982
Fisher RS, Stelzer F, Rock E, Malmud LS: Abnormal gallbladder emptying in patients with gallstones. Dig Dis Sci 27:1019–1024, 1982
Bobba VR, Kirshnamurthy GT, Kingston E, Turner FE, Brown PH, Langrell K: Gallbladder dynamics induced by a fatty meal in normal subjects and patients with gallstones: Concise communication. J Nucl Med 25:21–24, 1984
Kishk SMA, Darweesh RMA, Dodds WJ, Lawson TL, Stewart ET, Keen MK, Hassanein EH: Sonographic evaluation of resting gallbladder volume and postprandial emptying in patients with gallstones. AJR 148:875–879, 1987
Krishnamurthy GT, Bobba VR, Kingston E: Radionuclide ejection fraction: A technique for quantitative analysis of motor function of the human gallbladder. Gastroenterology 80:482–490, 1981
Jansen JBMJ, Lamers CBHW: Radioimmunoassay of cholecystokinin in human tissue and plasma. Clin Chim Acta 131:305–316, 1983
Jansen JBMJ, Lamers CBHW: Molecular forms of cholecystokinin in human plasma during infusion of bombesin. Life Sci 33:2197–2205, 1983
Hopman WPM, Jansen JBMJ, Rosenbusch G, Lamers CBHW: Effect of equimolar amounts of long-chain triglycerides and medium-chain triglycerides on plasma cholecystokinin and gallbladder contraction. Am J Clin Nutr 39:256–259, 1984
Beglinger C, Köhler E, Stadler GA, Jansen J, Gyr K: What is the maximal effective dose of caerulein in stimulating pancreatic secretion in man? Digestion 35:125–128, 1986
Krishnamurthy GT, Turner FE, Mangham D, Bobba VVR, White SA, Langrell K: Ceruletide intravenous dose-response study by a simplified scintigraphic technique. AJR 144:733–737, 1985
Pomeranz IS, Shaffer EA: Abnormal gallbladder emptying in a subgroup of patients with gallstones. Gastroenterology 88:787–791, 1985
Northfield TC, Kupfer RM, Maugdal DP, Zentler-Munro PL, Meller ST, Garvie NW, McCready R: Gallbladder sensitivity to cholecystokinin in patients with gallstones. Br Med J 280:143–144, 1980
Maugdal DP, Kupfer RM, Zentler-Munro PL, Northfield TC: Postprandial gallbladder emptying in patients with gallstones. Br Med J 280:141–143, 1980
Forgacs IC, Maisey MN, Murphy GM, Dowling RH: Influence of gallstones and ursodeoxycholic acid therapy on gallbladder emptying. Gastroenterology 87:299–307, 1984
Upp JR, Nealon WH, Singh P, Fagan CJ, Jonas AS, Greeley GH, Thompson JC: Correlation of cholecystokinin receptors with gallbladder contractility in patients with gallstones. Ann Surg 205:641–648, 1987
Hopman WPM, Jansen JBMJ, Rosenbusch G, Lamers CBHW: Cephalic stimulation of gallbladder in humans. Digestion 38:192–203, 1987
Hopman WPM, Jansen JBMJ, Lamers CBHW: Plasma cholecystokinin response to oral fat in patients with Billroth I and II gastrectomy. Ann Surg 199:276–280, 1984
Doty JE, Pitt HA, Kuchenbecker L, DenBesten L: Impaired gallbladder emptying before gallstone formation in the prairie dog. Gastroenterology 85:168–174, 1983
Brugge WR, Brand DL, Atkins HL, Lane BL, Abel WG: Gallbladder dyskinesia in chronic acalculous cholecystitis. Dig Dis Sci 31:461–467, 1986
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Masclee, A.A.M., Jansen, J.B.M.J., Driessen, W.M.M. et al. Plasma cholecystokinin and gallbladder responses to intraduodenal fat in gallstone patients. Digest Dis Sci 34, 353–359 (1989). https://doi.org/10.1007/BF01536255
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01536255