Abstract
An increased prevalence of gallstones was demonstrated in patients with liver cirhosis, higher in the advanced stages of the disease. Some studies have found impaired emptying of the gallbladder in cirrhotic patients. Our aim here was to investigate gallbladder emptying in cirrhotic patients with and without gallstones to find out whether emptying is further impaired in the presence of gallstones. The study group comprised 24 patients with liver cirrhosis and gallstones, 8 in each Child class. The controls were represented by 18 cirrhotic patients without gallstones, 6 in each Child class. Fasting gallbladder volume was calculated by ultrasound using the ellipsoid formula. Gallbladder emptying was evaluated for 90 min after ingestion of a solid–liquid meal (14 g fat, 425 kcal), by assessing minimal residual volume, gallbladder ejection fraction, and area under emptying curve at 15-min intervals. Statistical analysis was performed using the two-tailed Students' t test and Pearson's correlation coefficient. In controls, gallbladder fasting and residual volumes increased with the severity of cirrhosis, but gallbladder emptying did not change significantly. In cirrhotics with gallstones, gallbladder emptying decreased in Child C compared with Child A class patients and, also, compared to Child C controls. The number or size of gallstones, as well as the thickness of the gallbladder wall, did not correlate with gallbladder emptying parameters. Gallbladder contractility is impaired in patients with liver cirrhosis and gallstones. Hypomotility is proportional to the severity of liver disease. Gallbladder hypomotility might contribute to the increased gallstone formation in patients with advanced cirrhosis.
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REFERENCES
Bouchier IAD: Postmortem study of the frequency of gallstones in patients with cirrhosis of the liver. Gut 10:705–710, 1969
Nicholas P, Rinaudo PA, Conn HO: Increased incidence of cholelithiasis in Laennec's cirrhosis. Gastroenterology 63:112–121, 1972
Acalovschi M, Badea R, Dumitrascu D, Varga C: Prevalence of gallstones in liver cirrhosis: a sonographic study. Am J Gastroenterol 83:954–956, 1988
Samuel D Sattouf E, Degott C, Benhamou JP: Cirrhose et lithiase biliaire en France: une etude necroptique. Gastroenterol Clin Biol 12:39–42, 1988
Fornari F, Civardi G, Buscarini E, et al.: Cirrhosis of the liver. A risk factor for the development of cholelithiasis in males. Dig Dis Sci 35:1403–1408, 1990
Acalovschi M, Badea R, Pascu M: Incidence of gallstones in liver cirrhosis. Am J Gastroenterol 86:1179–1181, 1991
Conte D, Barisani D, Mandelli C, Bodini P, Borzio M, Pistoso S, Segala M, Aimo GP, Fraquelli M, Bianchi PA: Cholelithiasis in cirrhosis: Analysis of 500 cases. Am J Gastroenterol 86:1629–1631, 1991
Iber FL, Carudo G, Polepalle C, Kuchipudi V, Chinoy M: Increasing prevalence of gallstones in male veterans with alcoholic cirrhosis. Am J Gastroenterol 85:1593–1596, 1990
Maggi A, Solenghi D, Panzeri A, Borroni G, Cazzaniga M, Sangiovanni A, De Fazio C, Salerno F: Prevalence and incidence of cholelithiasis in patients with liver cirrhosis. Ital J Gastroenterol Hepatol 29:330–337, 1997
Fornari F, Imberti D, Squillante MM, Squassante L, Civardi G, Buscarini E, Cavanna L, Caturelli E, Buscarini L: Incidence of gallstones in a population with cirrhosis. J Hepatol 20:797–801, 1994
Elzouki AN, Nilsson S, Nilsson P, Verbaan H, Simanaitis M, Lindgren S: The prevalence of gallstones in chronic liver disease is related to degree of liver dysfunction. Hepato-Gastroenterol 46:2946–2950, 1999
Benvegnu L, Noventa F, Chemello L, Fattovich G, Alberti A: Prevalence and incidence of cholecystolithiasis in cirrhosis and relation to the etiology of liver disease. Digestion 58:293–298, 1997
Conte D, Fraquelli M, Fornari F, Lodi L, Bodini P, Buscarini L: Close relation between cirrhosis and gallstones: cross-sectional and longitudinal survey. Arch Intern Med 159:49–52, 1999
Kurihara N, Ide H, Omata T, Yonamine S, Mashima Y, Tanno M, Chiba K, Yamada H: Evaluation of gallbladder emptying in patients with chronic liver disease by 99mTc-EHIDA hepatobiliary scintigraphy. Radioisotopes 38:269–274, 1989
Acalovschi M, Dumitrascu DL, Csakany I: Gastric and gallbladder emptying of a mixed meal are not coordinated in liver cirrhosis-a simultaneous sonographic study. Gut 40:412–417, 1997
Li CP, Hwang SJ, Lee FY, Chang FY, Lin HC, Lu RH, Chu CJ, Lee SD: Evaluation of gallbladder motility in patients with liver cirrhosis: relationship to gallstone formation. Dig Dis Sci 45:1109–1114, 2000
Acalovschi M, Spirchez Z, Hamoudi WTY: Gallbladder hyporesponsiveness to an exogenous nitric oxide donor, glyceryl trinitrate, in patients with advanced liver cirrhosis. Am J Gastroenterol 94:3005–3009, 1999
Dodds WJ, Groh WJ, Darweesh RMA, Lawson TL, Kishk SMA, Kern MK: Sonographic measurement of gallbladder volume. Am J Roentgenol 145:1009–1111, 1985
Vlahcevic ZR, Yoshida T, Juttijudata P, Bell C, Swell L: Bile acid metabolism in cirrhosis. III. Biliary lipid secretion in patients with cirrhosis and its relevance to gallstone formation. Gastroenterology 64:298–303, 1973
Zhu JF, Shan LC, Chen WH: Changes in lipids, bilirubin and metal elements in the gallbladder bile in patients with cirrhosis of the liver. Chinese J Intern Med 33:767–769, 1994
Pascu M, Suciu A, Acalovschi M: Gallbladder bile composition in patients with cirrhosis of the liver [letter]. Rom J Gastroenterol 4:125, 1995
Poynard T, Lonjon I, Mathurin P, Abella A, Musset D, Bedossa P, Aubert A, Naveau S, Chaput JC: Prevalence of cholelithiasis according to alcoholic liver disease: a possible role of apolipoproteins AI and AII. Alcohol Clin Exp Res 19:75–80, 1995
Zhu JF: Gallbladder contractile function in patients with portal hypertension. Chung-Hua-Wai-Ko-Tsa-Chih 31:34–36, 1993
Attili AF, Casale R, DiLauro G, Festuccia V, Natali L, Pasqualetti P: Assessment of gallbladder contractility in patients with alcoholic hepatic cirrhosis after a fatty meal. A real-time ultrasonography study. Min Gastroenterol Dietol 38:45–48, 1992
Wang J, Luo J, Yu X: Study on biliary motility in cirrhotic patients with portal hypertension. Zhongua Gan Zang Bing Za Zhi 8:35–36, 2000
Kao CH, Hsieh JF, Tsai SC, Ho YJ, Chen SD: Evidence of impaired gallbladder function in patients with liver cirrhosis by quantitative radionuclide scintigraphy. Am J Gastroenterol 95:1301–1304, 2000
Sakata R, Ueno T, Torimura T, Sata M, Tanikawa K: Reduced contractility and histological changes in the gallbladder due to portal hypertension in a hamster cirrhosis model. Digestion 58:444–451, 1997
Mattera D, Regine R, Ambrogio G, Briguori C, Mazzacca G: Gallbladder motility impairment in liver cirrhosis. Gastroenterology 102:A321, 1992
Pompili M, Rapaccini GL, Caturelli E, Curro D, Montuschi P, D'Amato M, Aliotta A, Grattagliano A, Cedrone A, Anti M, Sciamanna V, Menini E: Gallbladder emptying, plasma levels of estradiol and progesterone, and cholecystokinin secretion in liver cirrhosis. Dig Dis Sci 40:428–434, 1995
Himeno S, Tarui S, Kanayama S: Plasma cholecystokinin responses after ingestion of liquid meal and intraduodenal infusion of fat, aminoacids or hydrochloric acid in man: analysis with region specific radioimmunoassay. Am J Gastroenterol 78:703–708, 1983
Barreca T, Franceschini R, Cataldi A, Rolandi E: Plasma somatostatin response to an oral mixed test meal in cirrhotic patients. J Hepatol 12:40–44, 1991
Konturek JW, Konturek SJ, Pawlik T, Domschke W: Physiological role of nitric oxide in gallbladder emptying in men. Digestion 58:373–378, 1997
Luman W, Ardill JEF, Armstrong E, Smith GD, Brett L, Lessells AM, Haynes WG, Gray GA, Mickley EJ, Webb DJ, Palmer KR: Nitric oxide and gallbladder motor function. Aliment Pharmacol Ther 12:425–432, 1998
Chawla A, Puthumana L, Thuluvath PJ: Autonomic dysfunction and cholelithiasis in patients with cirrhosis. Dig Dis Sci 46:495–498, 2001
Behar J, Lee KY, Thompson WR, Biancani P: Gallbladder contraction in patients with pigment and cholesterol stones. Gastroenterology 97:1479–1484, 1989
Everson GT, Nemeth A, Kourourian S, Zogg D, Berger Leff N, Dixon D, Githens JH, Pretorius D: Gallbladder function is altered in sickle hemoglobinopathy. Gastroenterology 96:1307–1316, 1989
KalayciAG, Albayrak D, Gunes M, Incesu L, Agac R: The incidence of gallbladder stones and gallbladder function in beta-thalassemic children. Acta Radiol 40:440–443, 1999
Portincasa P, Di Ciaula A, Vendemiale G, Palmieri V, Moschetta A, Vanberge-Henegouwen GP, Palasciano G: Gallbladder motility and cholesterol crystallization in bile from patients with pigment and cholesterol gallstones. Eur J Clin Invest 30:317–324, 2000
Jazrawi RP, Pazzi P, Petroni ML, Prandini N, Paul C, Adam JA, Gullini S, Northfield TC: Postprandial gallbladder motor function: refilling and turnover of bile in health and cholelithiasis. Gastroenterology 109:582–591, 1995
Pazzi P, Petroni ML, Prandini N, Adam JA, Gullini S, Northfield TC, Jazrawi RP: Postprandial refilling and turnover: specific gallbladder motor functions in patients with gallstone recurrence. Eur J Gastroenterol Hepatol 12:787–794, 2000
Cicala M, Guarino MP, Vavassori P, Alloni R, Emerenziani S, Arullani A, Pallone F: Ultrasonographic assessment of gallbladder bile exchanges in healthy subjects and in gallstone patients. Ultrasound Med Biol 27:1445–1450, 2001
Chen Q, Amaral J, Oh S, Biancani P, Behar J: Gallbladder relaxation in patients with pigment and cholesterol stones. Gastroentreology 113:930–937, 1997
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Acalovschi, M., Dumitrascu, D.L. & Nicoara, C.D. Gallbladder Contractility in Liver Cirrhosis: Comparative Study in Patients with and Without Gallbladder Stones. Dig Dis Sci 49, 17–24 (2004). https://doi.org/10.1023/B:DDAS.0000011596.33237.5c
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DOI: https://doi.org/10.1023/B:DDAS.0000011596.33237.5c