Abstract
To further elucidate the mechanism of impaired gallbladder emptying in diabetics with and without neuropathy, gallbladder function was assessed by ultrasonography following a medium-chain triglyceride (lipomul, 1.5 mg/kg) infusion into the duodenum and compared to that during intravenous infusion of cholecystokinin in diabetic women. Results were compared with five healthy control women. Mean (±sd) maximal percent gallbladder volume in diabetics following lipomul was reduced to 49±8% and after intravenous cholecystokinin to 47±9%, which was less than those in controls, 21±9% and 24±6%, respectively, but not significantly different. Further analysis of gallbladder emptying to lipomul differentiated two subgroups of diabetics: one subgroup (N=5) had emptying comparable to controls (responders), while the other (N=5) had very modest emptying (nonresponders). Two of the patients in the latter group had normal gallbladder emptying during exogenous cholecystokinin and their response would be compatible with visceral neuropathy. Blood levels of cholecystokinin, measured by bioassay, following lipomul and exogenous cholecystokinin were similar in controls and diabetics. Presence of diabetic neuropathy did not correlate with impaired gallbladder emptying. Follow up at 6 and 12 months of the three nonresponder diabetics revealed that no gallstones had developed and that two of them became responders to exogenous cholecystokinin. We conclude that: (1) following lipomul, about 50% of diabetics in this study have impaired gallbladder emptying, which is not strictly correlated with diabetic neuropathy; (2) this was not due to abnormal cholecystokinin release; (3) in diabetic patients with impaired gallbladder emptying another abnormality may be present in the gallbladder; and (4) impaired gallbladder contraction may not lead to gallstone formation in one-year follow-up.
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References
Lieber MM: The incidence of gallstones and their correlation with other diseases. Ann Surg 135:394–405, 1952
De Leon MP, Ferenderes R, Carulli N: Bile lipid composition and bile acid pool size in diabetes. Dig Dis 23:710–716, 1978
Grodzki M, Mazurkiewicz-Rozynska E, Czyzyk A: Diabetic cholecystopathy. Diabetologia 4:345–348, 1968
Gitelson S, Oppenheim D, Schwartz A: Size of the gallbladder in patients with diabetes mellitus. Diabetes 18:493–498, 1969
Gitelson S, Schwartz A, Fraenkel M, Chowers I: Gallbladder dysfunction in diabetes mellitus. The diabetic neurogenic gallbladder. Diabetes 12(4):308–311, 1963
Locke S, Tarsy D. The nervous system and diabetes.In Joslin's, Diabetes Mellitus, 12th ed. Marble A, Krall L, Bradley R, Christlieb A, Soeldner J (eds). Philadelphia, Lea and Febiger, 1985, pp 665–674
Taub S, Mariani A, Barkin JS: Gastrointestinal manifestation of diabetes mellitus. Diabetes Care 2:437–447, 1979
Atkinson M, Hosking DJ: Gastrointestinal complications of diabetes mellitus. Clin Gastroenterol 12:633–650, 1983
Yang R, Arem R, Chan L: Gastrointestinal tract complications of diabetes mellitus. Arch Intern Med 144:1251–1256, 1984
Onodera H, Sugawara H, Hirata T, Imai N, Nagasaki T, Yoda B, Toyota T, Goto Y: Diurnal profile of gallbladder size in diabetic patients: Ultrasonographic evaluation of diabetic neurogenic gallbladder. Tohoku J Exp Med 139:179–186, 1983
Tanno N, Koizumi M, Goto Y: The relationship between cholelithiasis and diabetes mellitus: Discussion of age, obesity, hyperlipidemia and neuropathy. Tohoku J Exp Med 154:11–20, 1988
Spellman SJ, Shaffer EA, Rosenthal L: Gallbladder emptying in response to cholecystokinin. Gastroenterology 77:115–120, 1979
Wiener I, Inoue K, Fagan CJ, Lilja P, Watson LC, Thompson JC: Release of cholecystokinin in man: Correlation of blood levels with gallbladder contraction. Ann Surg 194:321–325, 1981
Lilja P, Fagan CJ, Wiener I, et al: Infusion of pure cholecystokinin in humans. Correlation between plasma concentrations of cholecystokinin and gallbladder size. Gastroenterology 83:256–261, 1982
Walker JP, Khalil T, Wiener I, Fagan CJ, Townsend CM, Greeley GH, Thompson JC: The role of neurotensin in human gallbladder motility. Ann Surg 201:678–682, 1985
Lonovics J, Devitt P, Rayford PL, Thompson JC: Actions of VIP, somatostatin, and pancreatic polypeptide on gallbladder tension and cholecystokinin-stimulated gallbladder contraction in vitro. Surg Forum 30:407–409, 1979
Upp JR Jr, Nealon WH, Singh P, Fagan CJ, Jonas AS, Greeley GH Jr, Thompson JC: Correlation of cholecystokinin receptors with gallbladder contractility in patients with gallstones. Ann Surg 205:641–648, 1987
Keshavarzian A, Dunne M, Iber FL: Gallbladder volume and emptying in insulin-requiring male diabetics. Dig Dis Sci 32:824–828, 1987
Arezzo JC, Schaumburg HH, Laudadia C: Thermal Sensitivity tester: Device for quantitative assessment of thermal sense in diabetic neuropathy. Diabetes 35:590–592, 1986
Arezzo JC, Schaumburg JJ: The use of the Optacon as a screening device. A new technique for detecting sensory loss in individuals exposed to neurotoxins. J Occup Med 22:461–464, 1980
Sundkvist G, Almer L-O, Lilja B: Respiratory influence on heart rate in diabetes mellitus. Br Med J 1:924–925, 1979
Hopman W, Jansen J, Rosenbusch G, Lamers C: Effect of equimolar amounts of long-chain triglycerides and mediumchain triglycerides on plasma cholecystokinin and gallbladder contraction. Am J Clin Nutr 39:356–359, 1984
Dodd W, Groh W, Darweesh R, Lawson T, Kishk S, Kern M: Sonographic measurement of gallbladder volume. AJR 145:1009–1011, 1985
Liddle RA, Goldfine ID, Rosen MS, Taplitz RA, Williams JA: Cholecystokinin bioactivity in human plasma. J Clin Invest 75:1144–1152, 1985
Liddle RA, Goldfine ID, Williams JA: Bioassay of plasma cholecystokinin in rats: Effects of food, trypsin inhibitor, and alcohol. Gastroenterology 27:542–549, 1984
BMDP Computer Program and Statistical Software, 4th ed. Los Angeles, CA, 1988
Feldman M, Feldman M Jr: Incidence of cholelithiasis and liver disease in diabetes mellitus. Diabetes 3:305–308, 1954
Twiss JR, Carter F: The relationship of biliary tract disease and diabetes mellitus. Am J Med Sci 224:263–268, 1952
Gullo L, Bolondi L, Priori P, Casanova P, Labo G. Inhibitory effect of atropine on cholecystokinin-induced gallbladder contraction in man. Digestion 29:209–213, 1984
Hopman W, Jansen J, Rosenbusch G, Lamers C: Cephalic stimulation of gallbladder contraction in humans: Role of cholecystokinin and the cholinergic system. Digestion 38:197–203, 1987
Brennenman DW, Connor WE, Forker EL, Den Bensten L: The formation of abnormal bile and cholesterol gallstones from dietary cholesterol in the prairie dog. J Clin Invest 51:1495–1503, 1972
Fridhandler TM, Davidson JS, Shaffer EA: Defective gallbladder contractility in the group squirrel and prairie dog during the early stages of cholesterol gallstone formation. Gastroenterology 85:830–836, 1983
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
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This study was supported in part by the General Clinical Research Center of the Division of Research Resources, NIH (GCRC RR043), and grant AA07676-01A1 from the Alcohol, Drug Abuse and Mental Health Administration (awarded to J.E.V.).
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Shaw, S.J., Hajnal, F., Lebovitz, Y. et al. Gallbladder dysfunction in diabetes mellitus. Digest Dis Sci 38, 490–496 (1993). https://doi.org/10.1007/BF01316504
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DOI: https://doi.org/10.1007/BF01316504