Skip to main content
SpringerLink
Log in

Common Pathogenetic Mechanisms in Symptomatic, Uncomplicated Gallstone Disease and Functional Dyspepsia (Volume Measurement of Gallbladder and Antrum Using Three-Dimensional Ultrasonography)

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Following cholecystectomy for uncomplicatedgallstone disease (GS) some patients experiencepersistent symptoms suggesting an underlying functionaldisorder. To study this phenomenon, we have comparedsymptomatic GS with functional dyspepsia (FD) patients andhealthy individuals (C) with respect to putativepathogenetic mechanisms. Gallbladder and gastric antrumvolumes were estimated with three-dimensional (3D) ultrasonography before and 10 min afteringestion of 500 ml meat soup in 18 patients with GS.Volume estimation was performed digitally afterinteractive manual tracing and organ reconstruction inthree dimensions. Respiratory sinus arrhythmia (RSA)was calculated to index vagal tone. Abdominal symptomswere assessed by interview. The results were compared topreviously published data in patients with FD and C investigated with the exact samemethods. No significant differences were found betweengroups with respect to fasting gallbladder orgallbladder emptying. Antral volumes both fasting (P< 0.05) and postprandially (P < 0.01) were larger inGS and FD than in C. The soup meal induced dyspepticsymptoms in 2/18 (11% ) of C, 12/18 (67% ) of GS and15/17 (88%) of FD patients (P < 0.001). Compared with C, both GS and FD patients had significantlydecreased vagal tone (P < 0.001). There was nosignificant difference between GS and FD patients withrespect to antral volume, vagal tone, or symptoms. Weconcluded that both gallstone and functional dyspepsiapatients are characterized by dyspeptic symptoms inresponse to ingestion of 500 ml of meat soup, a widegastric antrum, low vagal tone, but normal gallbladder size and emptying. Thus, patients withsymptomatic, uncomplicated gallstone disease andfunctional dyspepsia seem to have common pathogeneticmechanisms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Jørgensen T, Teglbjerg JS, Wille-Jørgensen P, Bille T, Thorvaldsen P: Persisting pain after cholecystectomy. Scand J Gastroenterol 26:124–128, 1991

    Google Scholar 

  2. McSherry CK, Festenberg H, Calhoun WF, Lahman E, Virshup M. The natural history of diagnosed gallstone in symptomatic and asymptomatic patients. Ann Surg 202:59–63, 1985

    Google Scholar 

  3. Kraag N, Thijs C, Knipschild P: Dyspepsia—how noisy are gallstones. A meta-analysis of epidemiologic studies of biliary pain, dyspepstic symptoms, and food intolerance. Scand J Gastroenterol 30:411–421, 1995

    Google Scholar 

  4. Hausken T, Berstad A: Cisapride treatment of patients with nonulcer dyspepsia and erosive prepyloric changes. A double-blind, place bo-controlled trial. Scand J Gastroenterol 27:213–217, 1992

    Google Scholar 

  5. Hausken T, Svebak S, Wilhelmsen I, Tangen Haug T, Pettersson E, Olavsen K, Hveem K, Berstad A: Low vagal tone and antral dysmotility in patients with functional dyspepsia. Psychosom Med 55:12–22, 1993

    Google Scholar 

  6. Bolondi L, Bortolotti M, Santi V, Calletti T, Gaiani S, Labo G: Measurement of gastric emptying by real-time ultrasonography. Gastroenterology 89:752–759, 1985

    Google Scholar 

  7. Hausken T, Berstad A: Wide gastric antrum in patients with non-ulcer dyspepsia. Effect of cisapride. Scand J Gastroenterol 27:427–432, 1992

    Google Scholar 

  8. Troncon LEA, Thompson DG, Ahluwalia NK, Barlow J, Heggie L. Relations between upper abdominal symptoms and gastric distension abnormalities in dysmotility like functional dyspepsia and after vagotomy. Gut 37:17–22, 1995

    Google Scholar 

  9. Salet GAM, Samson M, Roelofs JMM, van Berge Henegouwen GP, Smout AJPM, Akkermans LMA: Responses to gastric distention in functional dyspepsia. Gastroenterology 108(4):A681, 1995

    Google Scholar 

  10. Troncon LE, Bennet RJ, Chatterton BE, Horowitz M: Abnormal intragastric distribution of food during gastric emptying in functional dyspepsia patients. Gut 35:327–332, 1994

    Google Scholar 

  11. Scott AM, Kellow JE, Shuter B, Cowan H, Corbett AM, Riley JW, Lunzer MR, Eckstein RP, Horschl R, Lam SK, Jones MP: Intragastric distribution and gastric emptying of solids and liquids in functional dyspepsia. Lack of influence of symptom subgroups and H. pylori-associated gastritis. Dig Dis Sci 38:2247–2254, 1993

    Google Scholar 

  12. Gilja OH, Hausken T, Wilhelmsen I, Berstad A: Impaired accommodation of proximal stomach to a meal in functional dyspepsia. Dig Dis Sci 41(4):689–696, 1996

    Google Scholar 

  13. Fischer RS, Seltzer F, Rock E, Malmud LS: Abnormal gallbladder emptying in patients with gallstones. Dig Dis Sci 27:1019–1024, 1982

    Google Scholar 

  14. Marzio L, DiFelice F, Laico MG, Imbimbo B, Lapenna B, Cuccurullo F: Gallbladder hypokinesia and normal gastric emptying of liquids in patients with dyspeptic symptoms. A double-blind placebo-controlled clinical trial with cisapride. Dig Dis Sci 37:262–267, 1992

    Google Scholar 

  15. Stone BG, Gavaler JS, Belle SH, Shreiner DP, Peleman RR, Sarva RP, Yingvorapant N, Van Thiel DH: Impairment of gallbladder emptying in diabetes mellitus. Gastroenterology 95:170–176, 1988

    Google Scholar 

  16. Marzio L, Capone F, Neri M, Mezzetti A, DeAngelis C, Cuccurullo F: Gallbladder kinetics in obese patients. Effect of a regular meal and a low caloric meal. Dig Dis Sci 33:4–9, 1988

    Google Scholar 

  17. Marzio L, DiFelice F, Celiberti V, DiGioacchino M, Mezzetti A, Cuccurullo F: Gallbladder emptying in duodenal ulcer patients having undergone Billroth II gastrectomy. Digestion 41:223–228, 1988

    Google Scholar 

  18. Thune N, Gilja OH, Hausken T, Matre K: A practical method for estimating enclosed volumes using 3D ultrasound. Eur J Ultrasound 3:83–92, 1996

    Google Scholar 

  19. Gilja OH, Thune N, Matre K, Hausken T, Ødegaard S, Berstad A: In vitro evaluation of three dimensional ultrasonography in volume estimation of abdominal organs. Ultrasound Med Biol 20:157–165, 1994

    Google Scholar 

  20. Gilja OH, Smievoll AI, Thune T, Matre K, Hausken T, Ødegaard S, Berstad A: In vivo comparison of 3D ultrasonography and magnetic resonance imaging in volume estimation of abdominal organs. Ultrasound Med Biol 21:25–32, 1995

    Google Scholar 

  21. Søndenaa K, Nesvik I, Solhaug JH, Søreide O: Randomisation to surgery or observation in patients with symptomatic gallbladder stone disease. The problem with evidence-based medicine in clinical practice Scand J. Gastroenterol 32:611–616, 1997

    Google Scholar 

  22. Hausken T, Thune N, Matre K, Gilja OH, Ødegaard S, Berstad A. Dynamic volume estimation of the gastric antrum and the gallbladder in patients with non-ulcer dyspepsia and erosive prepyloric changes, using three-dimensional ultrasonography. J Neurogastroenterol Motil 6:263–270, 1994

    Google Scholar 

  23. Eckberg DL: Human sinus arrhythmia as an index of vagal cardia outflow. J Appl Physiol 54:961–966, 1983

    Google Scholar 

  24. Grossman P, Svebak S: Respiratory sinus arrhythmis as an index of para sympathetic cardia control during active coping. Psychophysiology 24:228–235, 1987

    Google Scholar 

  25. Pauletzki J, Sackmann M, Holl J, Paumgartner G: Evaluation of gallbladder volume and emptying with a novel three-dimensional ultrasound system: Comparison with the sum-of cylinders and ellipsoid methods. J Clin Ultrasound 24:6:277–285, 1996

    Google Scholar 

  26. Hausken T, Svebak S, Berstad A: Vagal tone and antral size in duodenal ulcer and functional dyspepsia patients. Gut 35(4):A233, 1994

    Google Scholar 

  27. Undeland KA, Hausken T, Svebak S, Aanderud S, Berstad A: Wide gastric antrum and low vagal tone in patients with diabetes mellitus type 1 compared to patients with functional dyspepsia and healthy individuals. Dig Dis Sci 41:9–16, 1996

    Google Scholar 

  28. Mearin F, De Ribot X, Balboa A, Antolin M, Varas MJ, Malagelada JR: Duodenogastric bile reflux and gastrointestinal motility in pathogenesis of functional dyspepsia. Dig Dis Sci 40(8):1703–1709, 1995

    Google Scholar 

  29. Bradette M, Pare P, Douville P, Morin A: Visceral perception in health and functional dyspepsia. Crossover study of gastric distension with placebo and domperidone. Dig Dis Sci 36:52–58, 1991

    Google Scholar 

  30. Mearin F, Malegelada JR: Upper gut motility and perception in functional dyspepsia. Eur J Gastroenterol Hepatol 4:615–621, 1992

    Google Scholar 

  31. Greydanus MP, Vassallo M, Camilleri M, Nelson DK, Hanson RB, Thomforde GM: Neurohormonal factors in functional dyspepsia: Insights on pathophysiological mechanisms. Gastroenterology 100:1311–1318, 1991

    Google Scholar 

  32. Trimble KC, Farouk R, Pryde A, Douglas S, Heading RC: Heightened visceral sensation in functional gastrointestinal disease is not site-specific. Evidence for a generalized disorder of gut sensitivity. Dig Dis Sci 40(8):1607–1613, 1995

    Google Scholar 

  33. La Morte WW, Shoetz DJ, Birkett DH, Williams LF: The role of the gallbladder in the pathogenesis of cholesterol gallstones. Gastroenterology 77:580–592, 1979

    Google Scholar 

  34. Pauletzki J, Cicala M, Holl J, Sauerbruch T, Schafmayer A, Paumgartner G: Correlation between gallbladder fasting volume and postprandial emptying in patients with gallstones and healthy controls. Gut 34:1443–1447, 1993

    Google Scholar 

  35. Van Erpecum KJ, Van Berge Henegouwen GP, Stolk MFJ, Hopman WPM, Jansen JBMJ, Lamers CBHW: Effect of ursodeoxycholic acid on gallbladder contraction and cholecystokinin release in gallstone patients and normal subjects. Gastroenterology 93:836–842, 1990

    Google Scholar 

  36. Pomeranz IS, Shaffer EA: Abnormal gallbladder emptying in a subgroup of patients with gallstones. Gastroenterology 88:787–791, 1985

    Google Scholar 

  37. Masclee AA, Jansen JB, Driessen WM, Geusken LM, Lamers CB: Plasma cholecystokinin and gallbladder responses to intraduodenal fat in gallstones patients. Dig Dis Sci 34:353–359, 1989

    Google Scholar 

  38. Heddle R, Dent J, Read NW: Antropyloroduodenal motor responses to intraduodenal lipid infusions in healthy volunteers. Am J Physiol 254:G671–G679, 1988

    Google Scholar 

  39. Palasciano G, Serio G, Portincasa P, Palmieri V, Fanelli M, Velardi A, Gabrieli BC, Vinciguerra V: Gallbladder volume in adults, and relationship to age, sex, body mass index, and gallstones: A sonographic population study: Am J Gastroenterol 87(4):493–497, 1992

    Google Scholar 

  40. Haug TT, Svebak S, Hausken T, Wilhelmsen I, Berstad A, Ursin H: Low vagal activity as mediating mechanism for the relationship between personality factors and gastric symptoms in functional dyspepsia. Psychsom Med 56:181–186, 1994

    Google Scholar 

  41. Svebak S, Søndenaa K, Hausken T, Hammer A: Pain in gallstone patients: The significance of positive versus negative coping resources. Psychosom Med 57:A69, 1996

    Google Scholar 

Download references

Authors
  1. Trygve Hausken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karl Sondenaa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sven Svebak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Odd Helge Gilja
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Snorri Olafsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Svein Odegaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Odd Soreide
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Arnold Berstad
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hausken, T., Sondenaa, K., Svebak, S. et al. Common Pathogenetic Mechanisms in Symptomatic, Uncomplicated Gallstone Disease and Functional Dyspepsia (Volume Measurement of Gallbladder and Antrum Using Three-Dimensional Ultrasonography). Dig Dis Sci 42, 2505–2512 (1997). https://doi.org/10.1023/A:1018860511702

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1018860511702

Search

Navigation