cholecystokinin and Bile-Reflux

Cholecystokinin's role in regulations of gallbladder and gastric function was well documented. After cholecystectomy a secretion of cholecystokinin may be changed and observed symptoms are able to create a new clinical picture including biliary gastric reflux. In the study was noticed that in 12 patients after cholecystectomy the cholecystokinin secretion was increased in comparison to the period before operation. Observed increased levels of the enzyme were not in connection with biliary gastric reflux.

Topics: Adult; Bile Reflux; Cholecystectomy; Cholecystokinin; Female; Gastric Mucosa; Humans; Male; Middle Aged

Availability of specific cholecystokinin (CCK) receptor antagonists has the potential for contributing to delineation of the role of CCK in the development of pancreatitis and, perhaps, development of new therapeutic agents for treatment of the disorder. The purpose of this study was to evaluate the effect of a potent CCK receptor antagonist, CR 1409, on bile reflux pancreatitis. The opossum pancreatic duct enters the common duct in such a position that it is possible to ligate the common duct distal to the pancreatic duct, resulting in bile refluxing into the pancreatic duct and producing pancreatitis. CR 1409 was administered to opossums at the time of distal common duct ligation and at the time of cystic- and common ducts ligations. In a separate group, CR 1409 administration was begun 24 hours following onset of pancreatitis. Control experiments were performed, in which CR-1409 was not administered. Serum amylase, pancreas gland weights, inflammation, and systemic venous insulin, glucagon, and CCK concentrations were evaluated. Bile duct ligation resulted in significant hyperamylasemia, pancreas gland edema, inflammation, hyperglucagonemia, hypercholecystokinemia, and hypoinsulinemia. CR 1409, administered at the onset of pancreatitis, significantly decreased amylase concentrations, gland weight, and inflammation, when compared to control values. Hormonal changes associated with pancreatitis were also significantly altered by CR 1409 administration. When administered 24 hours following onset of pancreatitis, CR 1409 was not effective in altering the pancreatitis produced by bile duct ligation. The results suggest that CCK plays a permissive or contributory role in the inflammatory process and in associated hormonal changes during development of bile reflux pancreatitis in the opossum.

Topics: Amylases; Animals; Bile Reflux; Cholecystokinin; Common Bile Duct; Female; Glucagon; Insulin; Ligation; Male; Opossums; Organ Size; Pancreas; Pancreatitis; Proglumide; Receptors, Cholecystokinin

Topics: Bile Reflux; Biliary Tract Diseases; Cholecystokinin; Common Bile Duct Diseases; Eponyms; Humans; Radionuclide Imaging

We have studied the sensitivity and reproducibility of entero-gastric bile reflux measurements using a gamma camera. Aspiration of the stomach at the end of the study in a group of 14 patients showed that less than 1% of the administered HIDA was present in 7 patients who were judged reflux negative. In all 7 patients considered reflux positive, there was more than 1% of the dose in the stomach (median 8.2%, p less than 0.01 Mann-Whitney). The second group of 20 patients was studied twice in the same week with a 48 h interval between the tests. The results were reproduced in 15 patients (75%). Finally, the gamma camera technique was compared with nasogastric aspiration on a separate occasion. There was agreement in 16 patients out of 19(84%). These results suggest that the test is sensitive, and the lack of reproducibility is compatible with day to day variation in entero-gastric reflux.

Topics: Bile Reflux; Biliary Tract Diseases; Cholecystokinin; Duodenogastric Reflux; Humans; Imino Acids; Intubation, Gastrointestinal; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Time Factors

We used a Tc-99m-labeled hepatobiliary agent to measure the partition of hepatic bile between gallbladder and intestine in sixteen normal patients and nine patients with cholelithiasis. In normal subjects, the fractions of the hepatic bile that flow into the gallbladder and the small intestine were widely variable, with mean values of 69 +/- 7% (s.e.) and 31 +/- 7% respectively. Bile reflux into the common hepatic duct was rare, occurring during the first 2/3 of the gallbladder ejection period and only when the ejection fraction was greater than 59%. The gallbladder's mean latent period, ejection period, ejection fraction, and ejection rate were 2 +/- 1 min, 11 +/- 1 min, 59 +/- 4%, and 5.9%/min respectively. In patients with cholelithiasis, the fraction of hepatic bile flowing into the gallbladder was normal, but the ejection fraction was significantly reduced (p less than 0.005). For an equivalent dose of cholecystokinin, the gallbladder in cholelithiasis is less responsive than in normal subjects.

Topics: Adult; Animals; Bile Reflux; Cholecystokinin; Cholelithiasis; Female; Gallbladder; Hepatic Duct, Common; Humans; Imino Acids; Male; Middle Aged; Rabbits; Radionuclide Imaging; Technetium; Technetium Tc 99m Lidofenin; Technology, Radiologic

Duodenogastric reflux of bile and pancreatic secretions is known to induce acute chronic alterations of gastric and oesophageal mucosa. Several complex methods have been reported to demonstrate duodenogastric reflux (DGR) in man. The aim of this work was to describe a simple test for evaluation of DGR. The studied groups included: 1) 30 patients with DGR demonstrated by the radiological test of Capper and by endoscopic examination (group I); 2) 18 subjects without demonstrable DGR (group II). Bilirubin concentrations were measured in gastric juice collected for 10 min periods during one hour before and one hour after gallbladder stimulation by cholecystokinin-pancreozymin (CCK-PZ) (35 Ivy-dog Units). Bilirubin output was determined in the basal state (basal bilirubin output); maximal bilirubin peak (MBP) was determined by the highest of the collected samples following CCK-PZ administration. There was no significant difference between the two groups for basal bilirubin output. Analysis of the MBP showed that the two groups were significantly different (p less than 0.05). A duodenogastric reflux is present and can be quantitated when the MBP is above 200 microgram. Our results suggest that this method is available to evaluate the role of duodenogastric influx in gastric and/or oesophageal diseases.

Topics: Bile Reflux; Biliary Tract Diseases; Bilirubin; Cholecystokinin; Duodenal Diseases; Gastric Juice; Gastrointestinal Motility; Humans; Methods; Pylorus

99mTc-diethyl-IDA is completely excreted into the bile. When cholecystokinin is given after priming of the biliary tract with this tracer, gallbladder contraction leads to expulsion of bile into the duodenum. At the same time cholecystokinin causes contraction of the pylorus, which should normally prevent substantial reflux of tracer into the stomach. We have applied these physiological characteristics in a method to quantify biliary gastric reflux. Fourteen controls had a median reflux of 4.3% of the intravenous dose (93% of controls had values less than 9%). In 18 patients with Billroth II gastrectomies the median reflux was 46% (p less than 0.001). Patients with chronic gastritis (no. = 18) had also increased reflux (median 18.1%, p less than 0.001). The same was found in gastric ulcer (no. = 18, median 11.8%, p less than 0.003). In duodenal ulcer (no. = 7) increased reflux existed in only two patients with pyloric deformation. Patients with hiatal hernia did not show increased reflux (no. = 10, median 2.2%). Bilirubin measurements tended to underestimate reflux in pathological cases, whereas bile acid measurements and reflux percentages of tracer showed a close relationship (r = 0.87, p less than 0.001).

Topics: Bile Reflux; Biliary Tract Diseases; Cholecystokinin; Gastrectomy; Gastritis; Humans; Imino Acids; Methods; Stomach Ulcer; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid

To accurately quantitate dynamic events associated with gallbladder filling and emptying, we developed a cholescintigraphic technique in which the radionuclide 99mTc-HIDA excreted in bile was externally measured by a gamma camera interfaced to a computer programmed for data processing. Changes in activity with time were measured over the liver, bile ducts, gallbladder, small intestine, and stomach. The first 60 min were used to detect activity filling the gallbladder. Cholecystokinin was then infused at 0.020 U/kg/min for 30 min to initiate gallbladder contraction, while monitoring the evacuation of radionuclide into the small intestine and/or stomach. The stomach region was defined by a 99mTc-sulphur colloid swallow. With computer assistance, we were able to measure the rate at which the gallbladder filled, the fraction of liver activity that partitioned into the gallbladder instead of the duodenum, the rate of gallbladder empyting, and any gastric reflux. In 12 fasting, healthy subjects, three-fourths of the hepatic activity entered the gallbladder. After a 5-min time lag, gallbladder empyting commenced in response to the cholecystokinin, ejecting half its contents in 12 min, but still having a residual 25% after 30 min. Gallbladder evacuation was definitely slower in 6 patients with cholelithiasis, although filling appeared normal. One patient with gallstones underwent a repeat study after 4 mo on chenodeoxycholic acid therapy: Gallbladder filling, and especially emptying, deteriorated. Gastric reflux occurred only in 2 patients with gastroenterostomies who refluxed 2% of their gallbladder contents into the gastric remnant. Quantitative cholescintigraphy offers a new objective means to define gallbladder function and document bile reflux.

Topics: Adult; Aged; Bile Reflux; Biliary Tract Diseases; Cholecystokinin; Female; Gallbladder; Gallbladder Diseases; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium