Skip to main content
PMC home page
Gut logoLink to Gut
. 1997 Mar;40(3):412–417. doi: 10.1136/gut.40.3.412

Gastric and gall bladder emptying of a mixed meal are not coordinated in liver cirrhosis--a simultaneous sonographic study.

M Acalovschi 1, D L Dumitraşcu 1, I Csakany 1
PMCID: PMC1027095  PMID: 9135534

Abstract

BACKGROUND AND AIM: An impaired contractility has been suggested as a contributor to the increased incidence of gallstones in liver cirrhosis, but the few studies on gall bladder emptying in cirrhotics offered contradictory results. Ingestion of a meal triggers the physiological pathway of gall bladder emptying; therefore, it was decided to analyse postprandial kinetics by investigating simultaneously the rates of gastric and gall bladder emptying of a mixed meal in patients with liver cirrhosis. METHODS: Gastric and gall bladder emptying were measured using ultrasound techniques after a solid-liquid meal (14 g fat, 425 kcal) in 24 patients with liver cirrhosis and in 12 controls. None of the subjects had gall bladder disease. Sequential changes in cross sectional area of the gastric antrum and in gall bladder volume were represented as a monoexponential process after the test meal. Cirrhotic patients were analysed according to the severity of disease (Child classes). The presence of portal gastropathy was assessed by endoscopy. Differences between groups were assessed using the two tailed Student's t test for unpaired observations and the correlations by linear regression (Pearson's coefficient). RESULTS: It was found that gastric emptying after the solid-liquid meal was delayed in cirrhotic patients compared with controls. Gall bladder emptying was significantly diminished in cirrhotic patients: the area under curve was greater in Child A (p = 0.01), Child B (p = 0.04), and Child C (p = 0.014) cirrhotics compared with controls. No correlation was found between the variables of gastric and gall bladder emptying. Gall bladder refilling began earlier in cirrhotics than in controls, before completion of gastric emptying. CONCLUSIONS: These results indicate the lack of coordination between gastric and gall bladder emptying in liver cirrhosis. They also support the hypothesis that diminished gall bladder contractility might contribute to the increased gallstone formation in liver cirrhosis.

Full text

PDF
413

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baxter J. N., Grime J. S., Critchley M., Shields R. Relationship between gastric emptying of solids and gall bladder emptying in normal subjects. Gut. 1985 Apr;26(4):342–351. doi: 10.1136/gut.26.4.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bolondi L., Bortolotti M., Santi V., Calletti T., Gaiani S., Labò G. Measurement of gastric emptying time by real-time ultrasonography. Gastroenterology. 1985 Oct;89(4):752–759. doi: 10.1016/0016-5085(85)90569-4. [DOI] [PubMed] [Google Scholar]
  3. Charneau J., Petit R., Calès P., Dauver A., Boyer J. Antral motility in patients with cirrhosis with or without gastric antral vascular ectasia. Gut. 1995 Oct;37(4):488–492. doi: 10.1136/gut.37.4.488. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dapoigny M., Bonnafous J., Delasalle P., Abergel A., Pélissier E., Veyre A., Bommelaer G. Validation d'une méthode échographique de mesure de la vidange gastrique chez l'homme. Gastroenterol Clin Biol. 1991;15(3):199–203. [PubMed] [Google Scholar]
  5. Davion T., Capron J. P. La lithiase biliaire au cours de la cirrhose: oui, mais pourquoi? Gastroenterol Clin Biol. 1988 Jan;12(1):37–38. [PubMed] [Google Scholar]
  6. Dodds W. J., Groh W. J., Darweesh R. M., Lawson T. L., Kishk S. M., Kern M. K. Sonographic measurement of gallbladder volume. AJR Am J Roentgenol. 1985 Nov;145(5):1009–1011. doi: 10.2214/ajr.145.5.1009. [DOI] [PubMed] [Google Scholar]
  7. Fisher R. S., Rock E., Malmud L. S. Effects of meal composition on gallbladder and gastric emptying in man. Dig Dis Sci. 1987 Dec;32(12):1337–1344. doi: 10.1007/BF01296658. [DOI] [PubMed] [Google Scholar]
  8. Froehlich F., Gonvers J. J., Fried M. Role of nutrient fat and cholecystokinin in regulation of gallbladder emptying in man. Dig Dis Sci. 1995 Mar;40(3):529–533. doi: 10.1007/BF02064362. [DOI] [PubMed] [Google Scholar]
  9. Fullarton G. M., Meek A. C., Gray H. W., Bessent R. G. Gallbladder emptying following cholecystokinin and fatty meal in normal subjects. Hepatogastroenterology. 1990 Dec;37 (Suppl 2):45–48. [PubMed] [Google Scholar]
  10. Hendrickse M. T., Thuluvath P. J., Triger D. R. Natural history of autonomic neuropathy in chronic liver disease. Lancet. 1992 Jun 13;339(8807):1462–1464. doi: 10.1016/0140-6736(92)92042-e. [DOI] [PubMed] [Google Scholar]
  11. Himeno S., Tarui S., Kanayama S., Kuroshima T., Shinomura Y., Hayashi C., Tateishi K., Imagawa K., Hashimura E., Hamaoka T. Plasma cholecystokinin responses after ingestion of liquid meal and intraduodenal infusion of fat, amino acids, or hydrochloric acid in man: analysis with region specific radioimmunoassay. Am J Gastroenterol. 1983 Nov;78(11):703–707. [PubMed] [Google Scholar]
  12. Hopman W. P., Jansen J. B., Rosenbusch G., Lamers C. B. Cephalic stimulation of gallbladder contraction in humans: role of cholecystokinin and the cholinergic system. Digestion. 1987;38(4):197–203. doi: 10.1159/000199592. [DOI] [PubMed] [Google Scholar]
  13. Howard P. J., Murphy G. M., Dowling R. H. Gall bladder emptying patterns in response to a normal meal in healthy subjects and patients with gall stones: ultrasound study. Gut. 1991 Nov;32(11):1406–1411. doi: 10.1136/gut.32.11.1406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Isobe H., Sakai H., Satoh M., Sakamoto S., Nawata H. Delayed gastric emptying in patients with liver cirrhosis. Dig Dis Sci. 1994 May;39(5):983–987. doi: 10.1007/BF02087548. [DOI] [PubMed] [Google Scholar]
  15. Jacobs D. L., Quigley E. M., Rikkers L. F. Gastric compliance and motility in the portal hypertensive rat. J Invest Surg. 1992 Apr-Jun;5(2):109–114. doi: 10.3109/08941939209012427. [DOI] [PubMed] [Google Scholar]
  16. 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. 1989 Jun;38(6):269–274. doi: 10.3769/radioisotopes.38.6_269. [DOI] [PubMed] [Google Scholar]
  17. Lawson M., Everson G. T., Klingensmith W., Kern F., Jr Coordination of gastric and gallbladder emptying after ingestion of a regular meal. Gastroenterology. 1983 Oct;85(4):866–870. [PubMed] [Google Scholar]
  18. Lundgren O., Svanvik J., Jivegård L. Enteric nervous system. II. Physiology and pathophysiology of the gallbladder. Dig Dis Sci. 1989 Feb;34(2):284–288. doi: 10.1007/BF01536063. [DOI] [PubMed] [Google Scholar]
  19. Malmud L. S., Fisher R. S., Knight L. C., Rock E. Scintigraphic evaluation of gastric emptying. Semin Nucl Med. 1982 Apr;12(2):116–125. doi: 10.1016/s0001-2998(82)80003-2. [DOI] [PubMed] [Google Scholar]
  20. Marzio L., Capone F., Neri M., Mezzetti A., De Angelis C., Cuccurullo F. Gallbladder kinetics in obese patients. Effect of a regular meal and low-calorie meal. Dig Dis Sci. 1988 Jan;33(1):4–9. doi: 10.1007/BF01536623. [DOI] [PubMed] [Google Scholar]
  21. Marzio L., Giacobbe A., Conoscitore P., Facciorusso D., Frusciante V., Modoni S. Evaluation of the use of ultrasonography in the study of liquid gastric emptying. Am J Gastroenterol. 1989 May;84(5):496–500. [PubMed] [Google Scholar]
  22. Perreard M., Iconomidis N., Bernard C., Chayvialle J., Gerolami A. Influence d'un régime hypolipique sur le volume à jeun et la vidange post-prandiale de la vésicule biliaire. Gastroenterol Clin Biol. 1993;17(6-7):435–440. [PubMed] [Google Scholar]
  23. Pompili M., Rapaccini G. L., Caturelli E., Curró D., Montuschi P., D'Amato M., Aliotta A., Grattagliano A., Cedrone A., Anti M. Gallbladder emptying, plasma levels of estradiol and progesterone, and cholecystokinin secretion in liver cirrhosis. Dig Dis Sci. 1995 Feb;40(2):428–434. doi: 10.1007/BF02065433. [DOI] [PubMed] [Google Scholar]
  24. Reilly J. A., Jr, Forst C. F., Quigley E. M., Rikkers L. F. Gastric emptying of liquids and solids in the portal hypertensive rat. Dig Dis Sci. 1990 Jun;35(6):781–786. doi: 10.1007/BF01540184. [DOI] [PubMed] [Google Scholar]
  25. Sakamoto T., Fujimura M., Newman J., Zhu X. G., Greeley G. H., Jr, Thompson J. C. Comparison of hepatic elimination of different forms of cholecystokinin in dogs. Bioassay and radioimmunoassay comparisons of cholecystokinin-8-sulfate and -33-sulfate. J Clin Invest. 1985 Jan;75(1):280–285. doi: 10.1172/JCI111686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Stone B. G., Ansel H. J., Peterson F. J., Gebhard R. L. Gallbladder emptying stimuli in obese and normal-weight subjects. Hepatology. 1992 May;15(5):795–798. doi: 10.1002/hep.1840150508. [DOI] [PubMed] [Google Scholar]
  27. Takaoka M., Kubota Y., Tani K., Kin H., Ogura M., Fujimura K., Mizuno T., Inoue K. Simultaneous ultrasonic monitoring of gallbladder emptying and gastric emptying after liquid test meal. Intern Med. 1993 Oct;32(10):758–762. doi: 10.2169/internalmedicine.32.758. [DOI] [PubMed] [Google Scholar]
  28. Van Dis M. L., Vincent S. D. Diagnosis and management of autoimmune and idiopathic mucosal diseases. Dent Clin North Am. 1992 Oct;36(4):897–917. [PubMed] [Google Scholar]
  29. Wedmann B., Schaffstein J., Wegener M., Schmidt G., Coenen C., Ricken D. Sonographische Erfassung der Magenentleerung. Reliabilität und Validität der Antrumflächenmethode für Flüssigkeiten. Z Gastroenterol. 1990 Sep;28(9):448–452. [PubMed] [Google Scholar]
  30. Wedmann B., Schmidt G., Wegener M., Coenen C., Ricken D., Althoff J. Effects of age and gender on fat-induced gallbladder contraction and gastric emptying of a caloric liquid meal: a sonographic study. Am J Gastroenterol. 1991 Dec;86(12):1765–1770. [PubMed] [Google Scholar]
  31. Wegener M., Schaffstein J., Dilger U., Coenen C., Wedmann B., Schmidt G. Gastrointestinal transit of solid-liquid meal in chronic alcoholics. Dig Dis Sci. 1991 Jul;36(7):917–923. doi: 10.1007/BF01297141. [DOI] [PubMed] [Google Scholar]
  32. Yamamura T., Takahashi T., Kusunoki M., Kantoh M., Seino Y., Utsunomiya J. Gallbladder dynamics and plasma cholecystokinin responses after meals, oral water, or sham feeding in healthy subjects. Am J Med Sci. 1988 Feb;295(2):102–107. doi: 10.1097/00000441-198802000-00003. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES