Gallbladder kinetics in obese patients

Effect of a regular meal and low-calorie meal

Abstract

Gallbladder contractility has been studied in 21 obese patients >130% ideal weight) and 30 nonobese subjects before and at regular intervals after the administration of a regular solid-liquid meal, and after a low-calorie, low-fat meal used conventionally for weight-loss purposes (Modifast®). Gallbladder volume was determined by means of real-time ultrasonography, using a linear array scanner with a 3.5 MHz probe. In seven of the obese patients, gallbladder contractility was also evaluated after a 10-day regimen with Modifast. The obese group showed a statistically significant greater gallbladder fasting volume and blunted contractility than controls both after the ordinary and the low-calorie meal. The 10-day low-calorie regimen was associated with a statistically significant increment in fasting gallbladder volume, while the percent volume reduction after Modifast did not change. It is suggested that, in addition to metabolic factors, gallbladder hypocontractility in the obese may contribute to the high incidence of cholesterol gallstones noted in these patients. A low-calorie, low-fat diet augmenting gallbladder volume may favor bile stasis and therefore the likelihood of developing gallstones.

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References

  1. 1.

    Tucker LE, Tangedhal TN, Newmark SR: Prevalence of gallstones in obese Caucasian American woman. Int J Ob 6:247–251, 1982

    Google Scholar 

  2. 2.

    Den Besten L, Connor WE, Bell S: The effect of dietary cholesterol on the composition of human bile. Surgery 73:266–273, 1973

    PubMed  Google Scholar 

  3. 3.

    Bennion LJ, Grundy SM: Effect of obesity and caloric intake on biliary lipid metabolism in man. J Clin Invest 56:996–1011, 1975

    PubMed  Google Scholar 

  4. 4.

    Shaffer EA, Small DM: Biliary lipid secretion in cholesterol gallstone disease. J Clin Invest 59:828–840, 1977

    PubMed  Google Scholar 

  5. 5.

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

    PubMed  Google Scholar 

  6. 6.

    Grull NJ, Meyer PD, Den Besten L: The effect of cholesterol crystals on gallbladder functions in cholelithiasis. Surg Forum 28:412–413, 1977

    PubMed  Google Scholar 

  7. 7.

    Schlierf G, Schellenberg B, Stiehl A, Czygan P, Oster P: Biliary cholesterol saturation and weight reduction. Effect of fasting and low calorie diet. Digestion 21:44–49, 1981

    PubMed  Google Scholar 

  8. 8.

    Pitt HA, King W III, Mann LL, Roslyn JJ, Berquist WE, Ament ME, Den Besten L: Increased risk of cholelithiasis with prolonged parenteral nutrition. Am J Surg 145:106–112, 1983

    PubMed  Google Scholar 

  9. 9.

    Messing B, Bories C, Kunstlinger F, Bernier JJ: Does total parenteral nutrition induce gallbladder sludge formation and lithiasis? Gastroenterology 84:1012–1019, 1983

    PubMed  Google Scholar 

  10. 10.

    Everson GT, Braverman DZ, Johnson ML, Kern F Jr: A critical evaluation of real-time ultrasonography for the study of gallbladder volume and contraction. Gastroenterology 79:40–46, 1980

    PubMed  Google Scholar 

  11. 11.

    Angelin B, Einarsson K, Ewerth S, Leijd B: Biliary lipid composition in obesity. Scand J Gastroenterol 16:1015–1019, 1981

    PubMed  Google Scholar 

  12. 12.

    Whiting MJ, Watts JM: Supersaturated bile from obese patients without gallstones supports cholesterol cristals growth but not nucleation. Gastroenterology 86:243–248, 1984

    PubMed  Google Scholar 

  13. 13.

    Doty JE, Pitt HA, Kuchebeker SL, Den Besten L: Impaired gallbladder emptying before gallstone formation in the prairie dog. Gastroenterology 1985:168–174, 1983

    Google Scholar 

  14. 14.

    Fridhandler TM, Davison JS, Schaffer EA: Defective gallbladder contractility in the ground squirrel and prairie dog during the early stages of cholesterol gallstone formation. Gastroenterology 85:830-d836, 1983

    PubMed  Google Scholar 

  15. 15.

    Pellegrini CA, Ryan T, Broderick W, Way LW: Gallbladder filling and emptying during cholesterol gallstone formation in the prairie dog. A cholescintigraphic study. Gastroenterology 90:143–149, 1986

    PubMed  Google Scholar 

  16. 16.

    Braverman DZ, Johnson ML, Kern F Jr: Effect of pregnancy and contraceptive steroids on gallbladder function. N Engl J Med 302:362–364, 1980

    PubMed  Google Scholar 

  17. 17.

    Everson GT, McKinley C, Lawson M, Johnson M, Kern F Jr: Gallbladder function in human female: Effect of the ovulatory cycle, pregnancy and contraceptive steroids. Gastroenterology 82:711–719, 1982

    PubMed  Google Scholar 

  18. 18.

    Gibbs J, Young RC, Smith GP: Cholecystokinin decreases food intake in rats. J Comp Physiol Psychol 84:488–495, 1973

    PubMed  Google Scholar 

  19. 19.

    Collins SM, Weingarten HP: The role of gastrointestinal peptides in the control of food intake.In Surgery for the Morbidly Obese Patient. M Dietel (ed). London, Lea and Febiger, 1986 (in press)

    Google Scholar 

  20. 20.

    Collins SM, Conover KL, Forsyth PA, Weingarten HP: Endogenous cholecystokinin and intestinal satiety. Am J Physiol 249:R667-R671, 1985

    PubMed  Google Scholar 

  21. 21.

    Smith GP, Jerome C, Cushin BJ, Eterno R, Simansky KJ: Abdominal vagotomy blocks the satiety effect of cholecystokinin in the rat. Science 213:1036–1037, 1981

    PubMed  Google Scholar 

  22. 22.

    McLaughlin CL, Peikin SR, Baillie CA: Decreased pancreatic exocrine response to cholecystokinin in Zucker obese rats. Am J Physiol 242:G612-G619, 1982

    PubMed  Google Scholar 

  23. 23.

    Praissman S, Rizzo RS: Pancreatic CCK receptors in genetically obese rats; diminished number of binding sites with increased affinity compared to lean rats. Gastroenterology 84(5):1276, 1983

    Google Scholar 

  24. 24.

    McLaughlin CL, Baillie CA: Decreased sensitivity of Zucker obese rats to the putative satiety agent cholecystokinin. Physiol Behav 25:543–548, 1980

    PubMed  Google Scholar 

  25. 25.

    Lawson M, Everson GT, Klingensmith W, Kern F Jr: Coordination of gastric and gallbladder emptying after injection of a regular meal. Gastroenterology 85:866–870, 1983

    PubMed  Google Scholar 

  26. 26.

    Wright RA, Krinsky S, Fleeman C: Gastric emptying and obesity. Gastroenterology 85:747–751, 1983

    Google Scholar 

  27. 27.

    Horowitz M, Collins PJ, Harding PE, Shearman DJC: Abnormalities of gastric emptying in obese patients. Int J Ob 7:415–421, 1983

    Google Scholar 

  28. 28.

    Rayan JP: Motility of the gallbladder and biliary tree.In Physiology of the Gastrointestinal Tract. LR Johnson (ed). New York, Raven Press, 1981, pp 473–494.

    Google Scholar 

  29. 29.

    Bart RA, Brajch RC, Filly RA: Abdominal pseudotumor in childhood: Distended gallbladder with parenteral hyperalimentation. Am J Roentgenol 136:341–343, 1981

    Google Scholar 

  30. 30.

    Cano N, Cicero F, Ranieri F, Martin J, Di Costanzo J: Ultrasonographic study of gallbladder motility during total parenteral nutrition. Gastroenterology 91:313–317, 1986

    PubMed  Google Scholar 

  31. 31.

    Greenberg GR, Mckloy RF, Adrian TE, Chadwick VS, Baron JH, Bloom SR: Inhibition of pancreas and gallbladder by pancreatic polypeptide. Lancet 2:1280–1282, 1978

    PubMed  Google Scholar 

  32. 32.

    Johansson C, Kollberg B, Efendic S, Uvnas-Wallensten K: Effects of graded doses of somatostatin on gallbladder emptying and pancreatic enzyme output after oral glucose in man. Digestion 22:24–31, 1981

    PubMed  Google Scholar 

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Correspondence to Dr. Leonardo Marzio MD.

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Marzio, L., Capone, F., Neri, M. et al. Gallbladder kinetics in obese patients. Digest Dis Sci 33, 4–9 (1988). https://doi.org/10.1007/BF01536623

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Key words

  • obesity
  • gallbladder volume
  • real-time ultrasonography
  • weight reduction