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. 1999 Aug;45(2):264–268. doi: 10.1136/gut.45.2.264

Gall bladder emptying in severe idiopathic constipation

C Penning 1, H Gielkens 1, J Delemarre 1, C Lamers 1, A Masclee 1
PMCID: PMC1727617  PMID: 10403740

Abstract

BACKGROUND—It has been suggested that slow transit constipation (STC) may be part of a panenteric motor disorder.
AIM—To evaluate motility of an upper gastrointestinal organ, the gall bladder, in 16 patients with STC and 20 healthy controls.
METHODS—Gall bladder emptying (ultrasonography) was studied in response to neural, cephalic-vagal stimulation with modified sham feeding (MSF) for 90 minutes and in response to hormonal stimulation with cholecystokinin (CCK, 0.5 IDU/kg/h) for 60 minutes.
RESULTS—Fasting gall bladder volume in patients with STC (17 (2) cm3) was significantly (p<0.01) reduced compared with that in controls (24 (2) cm3). Gall bladder emptying in response to MSF was significantly reduced in patients with STC expressed both as percentage emptying (11 (5)% versus 22 (3)%; p<0.05) and as absolute emptying (2.1 (0.7) cm3 versus 4.9 (0.7) cm3; p<0.02). However, percentage gall bladder emptying in response to CCK was not different between patients and controls (73 (4)% versus 67 (4)%) although the absolute reduction in gall bladder volume was significantly (p<0.05) smaller in patients (10.7 (1.1) cm3 versus 15.3 (1.4) cm3).
CONCLUSIONS—Patients with slow transit constipation have smaller fasting gall bladder volumes, impaired gall bladder responses to vagal cholinergic stimulation, but normal gall bladder responses to hormonal stimulation with CCK. These results point to abnormalities in gastrointestinal motility proximal from the colon in slow transit constipation and more specifically, impaired neural responsiveness.


Keywords: slow transit constipation; gall bladder emptying; sham feeding; cholecystokinin

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Figure 1  .

Figure 1  

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Gall bladder volumes (mean (SEM)) in the fasting state, during, and after modified sham feeding (MSF) and in response to cholecystokinin (CCK) infusion in controls (open triangles) and patients with slow transit constipation (STC; closed triangles).

Figure 2  .

Figure 2  

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Individual data and mean of fasting gall bladder volumes (cm3) in controls and patients with slow transit constipation (STC). Means are represented by horizontal bars.

Figure 3  .

Figure 3  

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Individual data and mean of absolute gall bladder emptying (cm3) induced by modified sham feeding (MSF) in controls and patients with slow transit constipation (STC). Means are represented by horizontal bars.

Figure 4  .

Figure 4  

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Individual data and mean of absolute gall bladder emptying induced by cholecystokinin (CCK) in controls and patients with slow transit constipation (STC). Means are represented by horizontal bars.

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

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