cholecystokinin and Biliary-Dyskinesia

Motility disorders of the biliary tree [biliary dyskinesia, including both gallbladder dysfunction (GBD), and sphincter of Oddi dysfunction] are difficult to diagnose and to treat.. There is controversy in the literature in particular regarding the criteria that should be used to select patients for cholecystectomy (CCY) in cases of suspected GBD. The current review covers the history, diagnosis, and treatment of GBD. Key Messages: Only >85% of patients with suspected GBD have relief following CCY, a much lower rate than the nearly 100% success rate following CCY for gallstone disease. Unfortunately, the literature is lacking, and there are no universally agreed-upon criteria for selecting which patients to refer for operation, although cholecystokinin (CCK)-enhanced hepatobiliary iminodiacetic acid scan is often used, with emphasis on an abnormally low gallbladder ejection fraction or pain reproduction at CCK administration. There is a clear need for large, well-designed, more definitive, prospective studies to better identify the indications for and efficacy of CCY in cases of GBD.

Topics: Biliary Dyskinesia; Cholagogues and Choleretics; Cholecystectomy; Cholecystokinin; Gallbladder Diseases; Humans; Sphincter of Oddi Dysfunction

Topics: Biliary Dyskinesia; Cholecystectomy; Cholecystokinin; Humans; Patient Selection; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Diethyl-iminodiacetic Acid; Treatment Outcome

Laparoscopic cholecystectomy is accepted therapy for children with ill-defined abdominal pain and impaired gallbladder emptying (biliary dyskinesia). Follow-up shows poor clinical response in many of these patients. The purpose of this report is to identify clinical and radiographic predictors of successful outcome after cholecystectomy for biliary dyskinesia.. The authors retrospectively reviewed records of 51 children after laparoscopic cholecystectomy for biliary dyskinesia (1990 to 2003). Clinical symptoms, radiographic findings, and pathology were evaluated. Subjective clinical improvement is stratified using an established patient satisfaction score. Logistic regression analysis determines statistically independent predictors of successful outcome.. Thirty-eight of 51 (75%) patients were available for follow-up. Twenty-seven of 38 (71%) patients reported complete resolution of symptoms. Nausea was the only symptom predictive of successful outcome by univariate analysis (odds ratio, 5.00). A cholecystokinin-stimulated, gallbladder ejection fraction less than 15% also predicts successful outcome (odds ratio, 8.00). Children with an ejection fraction greater than 15% did not have predictable resolution of symptoms. When present with pain and nausea, gallbladder emptying less than 15% has a positive predictive value of 93% and a negative predictive value of 81%.. Together, nausea, pain, and decreased gallbladder emptying (<15%) most reliably predict which children will benefit from cholecystectomy for biliary dyskinesia.

Topics: Abdominal Pain; Adolescent; Biliary Dyskinesia; Child; Child, Preschool; Cholecystectomy, Laparoscopic; Cholecystokinin; Cohort Studies; Female; Follow-Up Studies; Gallbladder Emptying; Humans; Infant; Infant, Newborn; Male; Nausea; Predictive Value of Tests; Radiography; Retrospective Studies; Treatment Outcome

Biliary pain is commonly reported in household surveys with the presumed cause being gallstones. When gallstones are absent or other abnormalities as a potential cause of similar pain do not exist, a different approach is necessary. Although trans-abdominal ultrasound can detect stones down to 3-5 mm, the advent of endoscopic ultrasound provides an even better definition for microlithiasis of < 3 mm. Duodenal aspiration of bile can further detect cholesterol microlithiasis or bilirubin granules, another potential source of biliary-type pain and perhaps even pancreatitis. Only in this way can acalculous gallbladder disease be clearly defined. The percentage of cholecystokinin-stimulated gallbladder emptying has been reputed to be the most sensitive diagnostic test for 'biliary dyskinesia', but abnormality of gallbladder emptying can be due to a smooth muscle defect of the gallbladder itself or heightened tone in the sphincter of Oddi. The value of surgical intervention has not been clearly established. The advent of laparoscopic cholecystectomy, however, has increased the number of patients with acalculous biliary disease who undergo surgery. Surgery is best done using impaired gallbladder emptying as the criterion for operation with improved outcome. Often, following cholecystectomy, biliary pain does not resolve the so-called 'post cholecystectomy syndrome'. Absence of the gallbladder as a pressure reservoir leaves the sphincter of Oddi as the prime determinant of bile duct pressure. Sphincter of Oddi dysfunction also exists in patients with an intact biliary tract and may become evident following cholecystectomy. Biliary manometry has clarified who might benefit from sphincterotomy. Choledochoscintigraphy is a non-invasive preliminary test. Advent of visceral hypersensitivity and better definition of this entity has shown, that in some of these patients with type III sphincter of Oddi, dysfunction appears to reside in duodenal hyperalgesia. It is clear that improved criteria are required to perform gallbladder emptying and better techniques to detect visceral hypersensitivity. Nonetheless, functional biliary pain in the absence of gallstone disease is a definite entity and a challenge for clinicians.

Topics: Acalculous Cholecystitis; Bile Ducts; Biliary Dyskinesia; Cholecystectomy, Laparoscopic; Cholecystokinin; Gallbladder Emptying; Humans; Pain; Postcholecystectomy Syndrome; Sphincter of Oddi

The availability of objective and quantitative diagnostic tests in recent years has allowed more precise documentation of biliary dyskinesia. Biliary dyskinesia consists of two disease entities situated at two different anatomical locations: sphincter of Oddi spasm, at the distal end of the common duct, and cystic duct syndrome, in the gallbladder. Both conditions are characterized by a paradoxical response in which the sphincter of Oddi and the cystic duct contract (and impede bile flow) instead of undergoing the normal dilatation, when the physiological dose of cholecystokinin is infused. Quantitative cholescintigraphy can clearly differentiate one disease entity from the other. The therapies of choice are sphincterotomy, sphincteroplasty or antispasmodics for sphincter of Oddi spasm and cholecystectomy for cystic duct syndrome. After quantitative cholescintigraphy, the final impression should identify the disease entity by name to assist the referring physician in making an appropriate therapeutic decision; a mere statement that a test is consistent with biliary dyskinesia is no longer sufficient.

Topics: Aniline Compounds; Biliary Dyskinesia; Cholecystokinin; Common Bile Duct Diseases; Cystic Duct; Gallbladder; Glycine; Humans; Imino Acids; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Sphincter of Oddi

Topics: Bile; Biliary Dyskinesia; Biliary Tract; Cholecystokinin; Cholelithiasis; Cholestasis; Humans; Middle Aged; Muscle Contraction

Topics: Ampulla of Vater; Amyl Nitrite; Atropine; Biliary Dyskinesia; Cholangiography; Cholecystokinin; Common Bile Duct; Hepatic Duct, Common; Humans; Morphine

Functional gallbladder disorder is most commonly defined by biliary colic and low ejection fraction (EF) on cholescintigraphy. Biliary hyperkinesia is a controversial type of functional gallbladder disorder, and its definition and the role of cholecystectomy in treating functional gallbladder disorder remains unclear.. We conducted a retrospective review of patients who underwent cholecystokinin-stimulated cholescintigraphy and cholecystectomy at 3 Mayo Clinic sites between 2007 and 2020. Eligible patients were 18 years or older, presented with symptoms of biliary disease, had an EF greater than 50%, underwent cholecystectomy, and had no evidence of acute cholecystitis or cholelithiasis on imaging. We used receiver operating characteristics curve analysis to identify the optimal cutoff value that predicted symptom resolution within 30 days of cholecystectomy.. A total of 2,929 cholecystokinin-stimulated cholescintigraphy scans were performed during the study period; the average EF was 67.5% and the median EF was 77%. Analyzing those with EFs greater than or equal to 50% yielded 1,596 patients with 141 (8.8%) going on to have cholecystectomy. No significant differences were found in age, sex, BMI, final pathology between patients with and without pain resolution. Using a cutoff EF of 81% was significantly associated with pain resolution after cholecystectomy (78.2% for EF greater than or equal to 81% vs 60.0% for EF less than 81%, p = 0.03). Chronic cholecystitis was found in 61.7% of the patients on final pathology.. We determined that an EF cutoff of 81% is a reasonable upper limit of normal gallbladder EF. Patients with biliary symptoms and an EF greater than 81% but no evidence of biliary disease on ultrasound or scintigraphy can be classified as having biliary hyperkinesia. Based on our findings, we recommend cholecystectomy for this patient population.

Topics: Biliary Dyskinesia; Cholecystectomy; Cholecystokinin; Gallbladder Diseases; Humans; Hyperkinesis; Pain; Retrospective Studies

Cholecystokinin stimulated HIDA (CCK-HIDA) has been used to identify patients with biliary dyskinesia and select patients likely to benefit from cholecystectomy. The appropriate use of this study in children remains controversial and this study aims to better understand the utility of this test.. Children who underwent a CCK-HIDA for evaluation of abdominal pain over a 15-year period were included, after excluding infants and patient's s/p liver transplant. Relevant clinical and outcomes data were abstracted and analyzed.. 124 patients met inclusion criteria. Mean age was 14.5 ± 2.6 years, Mean BMI was 27.9 ± 9.9 and 96 (77.4%) presented with right upper quadrant or epigastric pain. The mean ejection fraction (EF) was 58.5 ± 31.8%, with 37 (29.8%) < 35% EF. Using receiver operating curve analysis no specific EF threshold value predictive of resolution of symptoms was identified (AUC 0.510; p = 0.94). Using EF <35% and >35% and <20% and >20%, no association was noted with partial/complete resolution of symptoms. On multivariate regression analysis neither EF nor pain reproduction with CCK administration were independently associated with resolution of symptoms.. These data suggest that the CCK-HIDA scan is a poor predictor of benefit from cholecystectomy. Prospective large studies would help in identifying better criterion for patient selection, especially with the trend of increasing surgery for functional gallbladder disorders.. Case cohort.. IV.

Topics: Abdominal Pain; Adolescent; Biliary Dyskinesia; Child; Cholecystokinin; Humans; Imino Acids; Prospective Studies; Retrospective Studies

Biliary dyskinesia (BD) is a motility disorder of the gallbladder that can result in right upper quadrant (RUQ) pain, nausea, vomiting, and diarrhea. Cholecystectomy is considered the standard of care for BD. Up to 23 per cent of pediatric patients who undergo surgery for BD have persistent symptoms postoperatively. We performed a retrospective review to identify preoperative factors significantly associated with symptom resolution after cholecystectomy. We retrospectively reviewed pediatric patients aged 10-17 years diagnosed with BD who underwent cholecystectomy between 2006 and 2016. Patients were divided into two groups based on postoperative symptom resolution. Chi-squared and student

Topics: Abdominal Pain; Adolescent; Biliary Dyskinesia; Child; Cholagogues and Choleretics; Cholecystectomy, Laparoscopic; Cholecystokinin; Constipation; Female; Gallbladder; Humans; Male; Nausea; Retrospective Studies; Symptom Assessment; Treatment Outcome

Despite the increasing use of fatty meal (FM) as a substitute for cholecystokinin (CCK) in pain reproduction during hepato-imino-diacetic acid (HIDA) scan in functional gallbladder disorder, there are no studies comparing the differences between CCK and FM. The present study was to compare the efficacy of FM in comparison of CCK in FGBD application.. Patients undergoing HIDA scans from August 2013 to May 2014 were divided into two groups: those undergoing CCK-stimulated HIDA scan versus FM-stimulated HIDA scan. These groups were compared according to demographics and HIDA results.. Of 153 patients, 70 received CCK and 83 FM. There was no difference regarding age, gender, gallstones, gallbladder ejection fraction and time to visualization. However, significantly more of the patients receiving CCK than FM experienced pain reproduction (61% vs 30%, P<0.01).. Stimulation of gallbladder contractility with a FM during HIDA is less than half as likely to reproduce biliary symptoms compared to CCK, despite similar ejection fractions and other parameters. It is essential that providers account for this difference when counseling patients regarding cholecystectomy for functional gallbladder disorder.

Topics: Abdominal Pain; Adolescent; Adult; Aged; Aged, 80 and over; Biliary Dyskinesia; Cholecystectomy; Cholecystokinin; Dietary Fats; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Predictive Value of Tests; Radiopharmaceuticals; Vitamin K; Young Adult

To evaluate clinical outcomes in patients with typical biliary pain, normal ultrasonic findings, and a positive (99m)technetium (Tc)-labelled hepatic iminodiacetic acid analogue (HIDA) scintigraphy with cholecystokinin (CCK) provocation indicating gallbladder dyskinesia, as per Rome III criteria, undergoing laparoscopic cholecystectomy (LC).. Consecutive patients undergoing LC for gallbladder dyskinesia were identified retrospectively. They were followed up by telephone interview and review of the electronic case records to assess symptom resolution.. One hundred consecutive patients (median age 44; 80% female) with abnormal gallbladder ejection fraction (GB-EF <35%) were followed up for a median of 12 months (range 2-80 months). Following LC, 84% reported symptomatic improvement and 52% had no residual pain. Twelve percent had persisting preoperative-type pain of either unchanged or worsening severity. Neither pathological features of chronic cholecystitis (87% of 92 incidences when histology available) nor reproduction of pain on CCK injection were significantly predictive of symptom outcome or pain relief post-LC.. In one of the largest outcome series of gallbladder dyskinesia patients in the UK with a positive provocation HIDA scintigraphy examination and LC, the present study shows that the test is a useful functional diagnostic tool in the management of patients with typical biliary pain and normal ultrasound, with favourable outcomes following surgery.

Topics: Adolescent; Adult; Aged; Biliary Dyskinesia; Cholecystectomy, Laparoscopic; Cholecystokinin; Female; Humans; Imino Acids; Male; Middle Aged; Patient Satisfaction; Radionuclide Imaging; Retrospective Studies; Technetium; Treatment Outcome; Young Adult

Fatty infiltration of the internal organs--and the inflammation associated with it--is an increasingly common cause of gallbladder dysfunction. Here's what to keep in mind to identify it without delay.

Topics: Algorithms; Biliary Dyskinesia; Cholagogues and Choleretics; Cholecystectomy; Cholecystokinin; Endoscopy, Digestive System; Humans; Imino Acids; Obesity

Studies on biliary dyskinesia have been based on short-term surgical follow-up and do not take into consideration that most patients are discharged from surgical follow-up after the first postoperative visit and that for persistent or recurrent symptoms they are frequently seen by primary care providers and subsequently referred to gastroenterologists. We aimed to study this pattern and assess which factors predict patients that will benefit from cholecystectomy.. This is a retrospective analysis of medical records of patients who underwent cholecystectomy for biliary dyskinesia from February 2001 to January 2010 with a minimum postoperative follow-up of 6 months.. At initial surgical follow-up, 19 of 141 (13.4%) patients said they had persistent symptoms. However, when subsequent visits were analyzed, 61 of 141 (43.3%) patients with persistent or recurrent symptoms saw their primary care provider. These symptoms were epigastric or right upper quadrant pain in 43 patients or 30% of those undergoing cholecystectomy. The only factor that distinguished patients with and without resolution of symptoms after cholecystectomy was the pathologic finding of inflammation (p = 0.02).. Cholecystectomy does not appear to be as effective for biliary dyskinesia when long-term follow-up is evaluated.

Topics: Abdominal Pain; Adolescent; Adult; Aged; Biliary Dyskinesia; Child; Cholecystectomy; Cholecystitis; Cholecystokinin; Female; Follow-Up Studies; Gastroenterology; Humans; Male; Middle Aged; Patient Selection; Primary Health Care; Recurrence; Referral and Consultation; Retrospective Studies; Treatment Outcome; Young Adult

The (99m) technetium labelled hepato imino diacetic acid (HIDA) scan is widely used in the investigation of patients with typical biliary pain but whose trans-abdominal ultrasound scan (US) is normal. Although the standard measure by which the HIDA scan is deemed positive is the presence of an ejection fraction (EF) of <35% following provocation with cholecystokinin (CCK), there still remains debate as to the usefulness of this measure. The aim of this study was to compare the roles of EF and symptom provocation following CCK infusion in relation to the outcome following laparoscopic cholecystectomy (LC). More specifically, we aimed to review the resolution of symptoms for our significant population of patients with normal HIDA scan EFs for whom surgery has traditionally been deemed inappropriate.. All patients undergoing LC for a presumed diagnosis of biliary dyskinesia were identified from a prospectively maintained database. Data were collected regarding pre-operative symptoms, EF and symptom provocation during the CCK HIDA scan, histological findings, early symptomatic outcome, and medium-term follow-up.. During the period from March 2006 to October 2009, 42 patients with biliary symptoms but a negative US were referred for assessment by a single surgeon. There were 31 women and 11 men with a mean age of 39.0 ± 12.6 years. All underwent a CCK HIDA scan of which 17 were positive with an EF <35% and the remaining 25 were negative. All patients reported recreation of symptoms following administration of CCK. All gallbladders were delivered intact for histological assessment and all but one showed evidence of chronic cholecystitis. At each postoperative visit, approximately 2 weeks following the procedure, all patients reported resolution of symptoms. After a mean of 18.7 ± 12.1 months symptom recurrence had been noted in only one of 42 (2.4%).. The CCK HIDA scan is a useful study in the investigation of acalcalous cholecystitis; however, we would suggest that recreation of symptoms following CCK provocation is superior to EF for the identification of underlying chronic cholecystitis. Indeed, a normal gallbladder ejection fraction does not necessarily rule out a biliary aetiology of symptoms for this patient population.

Topics: Adult; Biliary Dyskinesia; Cholecystectomy, Laparoscopic; Cholecystokinin; Female; Follow-Up Studies; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Pain; Predictive Value of Tests; Radionuclide Imaging; Technetium; Treatment Outcome

For children with upper abdominal pain and evaluation for acalculous biliary disease, laparoscopic cholecystectomy is an accepted treatment with inconsistent outcomes. The purpose of this study was to identify predictors of outcomes.. One hundred sixty-seven children underwent laparoscopic cholecystectomy at a single children's hospital. Radiographic findings, histopathology, family history, and demographics (sex, age, height, weight, body mass index-for-age percentile) were evaluated as predictors of postoperative symptomatic resolution using a binomial probability model. The data for radiologic studies and pathologic specimens were obtained via re-review in a blinded fashion.. Of 167 children, 43 (25.7%) had a preoperative diagnosis of biliary dyskinesia and 41 (95.3%) had documented follow-up. Mean follow-up was 8.4 months. Twenty-eight patients (68.3%) had symptom resolution. Ejection fraction less than or equal to 15%, pain upon cholecystokinin injection, and a family history of biliary disease were not predictors of symptomatic resolution. Nonoverweight patients (body mass index-for-age <85th percentile) were more likely to have symptom resolution than their overweight counterparts (odds ratio, 2.13). Most patients (68.3%) had a pathologic gallbladder on blinded review. However, this did not correlate with outcome.. Most gallbladders removed for biliary dyskinesia are pathologic. Being overweight can be considered a relative contraindication to cholecystectomy for biliary dyskinesia.

Topics: Abdominal Pain; Adolescent; Biliary Dyskinesia; Body Mass Index; Child; Cholecystectomy, Laparoscopic; Cholecystitis; Cholecystokinin; Cohort Studies; Colic; Contraindications; Dietary Fats; Female; Gallbladder; Humans; Imino Acids; Male; Overweight; Radiography; Risk Factors; Single-Blind Method; Stroke Volume; Treatment Outcome; Young Adult

Topics: Biliary Dyskinesia; Cholecystokinin; Female; Gallbladder; Humans; Imino Acids; Male; Radionuclide Imaging

The purpose of this study was to determine the efficacy of 3D and 4D ultrasound in correlation with hepatoiminodiacetic acid (HIDA) scanning for calculating gallbladder ejection fraction (EF).. A prospective study was conducted with 40 adult patients with suspected gallbladder dyskinesia. Cholecystokinin-provoked (99m)Tc-HIDA scintigraphy was performed, and concurrent 3D and 4D ultrasound images of the gallbladder were obtained before cholecystokinin infusion and 20, 30, and 40 minutes after infusion. The EF values calculated from the ultrasound images and HIDA scan were compared.. The gallbladder EF values (mean ± standard error of the mean) calculated 20 minutes after cholecystokinin infusion from HIDA scans and 3D and 4D ultrasound images were 54.1% ± 5.0%, 58.9% ± 6.3%, and 62.8% ± 5.5%. Thirty minutes after infusion the EF values were 56.3% ± 4.7%, 56.9% ± 5.7%, and 59.1% ± 4.6%. The numbers of patients with an EF less than 50% were 14, 12, and 13, and the numbers with an EF less than 35% were 10, seven, and eight. For the patients with an EF less than 50%, the kappa agreement between HIDA scanning and 3D ultrasound was 0.89 (95% CI, 0.73-1.00), between HIDA scanning and 4D ultrasound was 0.83 (95% CI, 0.65-1.00), and between 3D and 4D ultrasound was 0.83 (95% CI, 0.64-1.00).. Both 3D and 4D ultrasound techniques correlate well with HIDA scanning for calculating gallbladder EF in patients with suspected biliary dyskinesia.

Topics: Adult; Aged; Analysis of Variance; Biliary Dyskinesia; Cholecystokinin; Contrast Media; Female; Gallbladder Emptying; Humans; Imaging, Three-Dimensional; Imino Acids; Male; Middle Aged; Positron-Emission Tomography; Prospective Studies; Technetium; Ultrasonography

Gallbladder dyskinesia (GD) is controversial. We sought to determine the success rate of cholecystectomy or observation in treating patients with GD with intervention decisions based upon clearly defined symptoms.. Ninety-three consecutive patients with documented GD were enrolled into a 2-year prospective study. Based upon the presenting symptoms categorized as either classic for gallbladder pathology or atypical, patients underwent cholecystectomy (classic) or observation (atypical). We defined dyskinesia as a cholecystokinin (CCK)-stimulated ejection fraction (EF) <35% on nuclear cholescintigraphy and a negative gallbladder ultrasound.. Classic gallbladder symptoms were identified in 61 patients and an atypical presentation occurred in 32 patients. The EF with CCK stimulation was not significantly different between the groups (19+/-9% vs. 16+/-7%, P=0.12). Of those with atypical symptoms, 28% (9 out of 32) had resolution of their symptoms without surgery. About 72% (23 out of 32) had worsening or progressive symptoms that did not resolve during observation, and later underwent surgery. Of these, 57% (13 out of 23) had resolution of their symptoms after surgery, but 43% (10 out of 23) had no improvement. Of those with classic symptoms, 60 patients underwent laparoscopic cholecystectomy with resolution of symptoms in 58 (97%). Patients with classic symptoms were 22 times more likely to have relief after cholecystectomy (odds ratio 22.3, P=0.0002). Eight patients had their symptoms recur more than 1 year after surgery (3 atypical and 5 classic) such that at long-term follow-up, cholecystectomy had helped only 43% of the atypical patients and 88% of the classic patients.. Classic biliary symptoms are more predictive of success after cholecystectomy in patients with GD than is EF. The symptoms that are most predictive of success after surgery are right upper quadrant pain, pain after meals, and reproduction of the pain after CCK administration. Patients with atypical symptoms are much less likely to have improvement after surgery and should be observed; however, recurrent or progressive symptoms should prompt intervention if all additional testing is negative.

Topics: Adult; Biliary Dyskinesia; Cholagogues and Choleretics; Cholecystectomy; Cholecystokinin; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Time Factors; Treatment Outcome

Experience with laparoscopic cholecystectomy for biliary dyskinesia in children remains limited. The aim of this study was to examine the results of a single institution's experience with laparoscopic cholecystectomy for the treatment biliary dyskinesia in the pediatric population. Medical records were reviewed on all patients younger than age 18 who underwent laparoscopic cholecystectomy at our institution from July 2004 to December 2006. Patients undergoing surgery for biliary dyskinesia, as evidenced by a preoperative gallbladder ejection fraction of 40 per cent or less, comprised the study group. Of the 51 pediatric laparoscopic cholecystectomies, 30 (58.8%) were performed for biliary dyskinesia. The patients' ages ranged from 7 to 17 (mean, 12.67 years; SD, 2.75). Symptoms consisted of chronic right upper quadrant pain (96.67%), nausea/vomiting (73.33%), back pain (30.0%), weight loss (13.33%), and a history of pancreatitis (6.66%). The amount of time between onset of symptoms and surgery was as follows: 1 to 3 months (34.62%), 4 to 6 months (30.77%), 7 to 12 months (7.69%), and greater than 1 year (26.92%). Gallbladder ejection fraction ranged from 1 to 36 per cent (mean, 14.7%). Seven of the 30 (26.67%) underwent endoscopic evaluation as part of their preoperative workup (six upper endoscopy, one colonoscopy), all of which were noncontributory. Pathology revealed chronic cholecystitis in 26 of 30 (93.3%), no abnormalities in three of 30 (10.0%), and unexpected cholelithiasis in one of 30 (3.33%). No perioperative complications were encountered. Twenty-nine of the 30 patients were available for follow up and all but one reported relief of symptoms (96.55%). This study supports the use of laparoscopic cholecystectomy as a safe and effective treatment for biliary dyskinesia in the pediatric population. The success rate in our study was substantially higher than that reported in previous series. Routine preoperative endoscopy was not used and was reserved for investigation of ambiguous or unrelated complaints.

Topics: Abdominal Pain; Adolescent; Age Factors; Biliary Dyskinesia; Child; Cholecystectomy, Laparoscopic; Cholecystokinin; Cohort Studies; Endoscopy; Female; Humans; Male; Retrospective Studies; Treatment Outcome

The outcome of laparoscopic cholecystectomy for patients who present with "classic" biliary colic without evidence of cholelithiasis or acute inflammation (biliary dyskinesia) is not well documented. This study evaluates whether a cholecystokinin dimethyl iminodiacetic acid (CCK-HIDA) scan can predict relief of symptoms in this group of patients.. Patients who underwent laparoscopic cholecystectomy after a normal ultrasound and with an abnormal dimethyl iminodiacetic acid scan were retrospectively reviewed. Symptomatic improvement was correlated with degree of dyskinesia, histologic findings, sex, and age.. One hundred seventy-six patients were studied and 69% were available for followup at a mean interval of 16 months. One hundred fourteen patients (94%) had complete or partial relief of symptoms. No correlation was found between degree of relief and degree of impaired ejection (31% to 50% versus <30%), the histologic findings, sex, or age.. Abnormal cholecystokinin dimethyl iminodiacetic acid scan effectively predicts relief of symptoms in patients undergoing laparoscopic cholecystectomy for biliary dyskinesia.

Topics: Biliary Dyskinesia; Cholecystectomy, Laparoscopic; Cholecystokinin; Female; Gastrointestinal Agents; Humans; Imino Acids; Male; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Treatment Outcome

A gallbladder ejection fraction (EF) on cholescintigraphy of less than 35% after cholecystokinin (CCK) has been considered to be pathophysiologic and an indication for laparoscopic cholecystectomy (LC).. All patients undergoing LC for biliary dyskinesia between 1994 and 2001 were prospectively entered into a database. These patients were retrospectively evaluated with regard to demographics, the number of preoperative studies obtained, postoperative symptoms, and the number of postoperative studies obtained.. Sixty patients underwent LC for biliary dyskinesia. The mean gallbladder EF was 14%, and 75% of patients were asymptomatic postoperatively. Persistent symptoms prompted further investigation in 6% of patients with a gallbladder EF <14% and in 35% of patients with an EF between 14 and 35% (p = 0.05).. Laparoscopic cholecystectomy alleviated symptoms in 94% of patients with a gallbladder EF <14% after CCK injection. The diagnostic significance of a preoperative CCK cholescintigram (EF 14-35%) needs further investigation.

Topics: Adult; Biliary Dyskinesia; Cholecystectomy, Laparoscopic; Cholecystokinin; Female; Humans; Male; Radionuclide Imaging

Patients with acalculous biliary-like pain present a difficult clinical challenge. Our aim was to evaluate the outcome of patients with recurrent biliary-like pain without gallstones who underwent testing of gallbladder ejection fraction (GBEF) by cholecystokinin-cholescintigraphy (CCK-CS) in order to determine clinical factors that may predict symptom resolution. We reviewed the records of patients with recurrent acalculous biliary-like pain who underwent CCK-CS from January 1995 to December 1999. For comparison, we also studied an age- and sex-matched group of patients who underwent cholecystectomy for symptomatic cholelithiasis. Outcome was obtained by telephone interview, using a scale from 0 to 3 where 0 = no improvement and 3 = clinical remission. Patient demographics, predominant symptom(s), method of management, gallbladder pathology, and response to treatment were recorded. One hundred twenty-nine patients underwent CCK-CS. Of 69 with an abnormal GBEF, 48 (70%) were available for interview. Forty patients underwent cholecystectomy. Twenty-seven patients reported symptom resolution after surgery while 4 nonsurgical patients reported the same (P = NS). Univariate analysis revealed no association between symptom outcome and presence of gastrointestinal symptom(s), severity and duration of abdominal pain, management, or gallbladder pathology. In addition, no GBEF cutoff level predicted symptom outcome. Of the remaining 60 patients with a normal GBEF, 30 (50%) were available for interview. Twenty-eight patients in this group were managed medically and 2 patients underwent cholecystectomy. Eighteen patients managed medically were asymptomatic, as were the 2 who underwent cholecystectomy. There was no difference in symptom outcome between patients who had GBEF >35% vs <35%. In conclusion, in a group of patients with recurrent acalculous biliary-like pain who underwent CCK-CS, we found a high rate of symptom resolution following cholecystectomy; however, this was not statistically different from a smaller cohort who did not undergo surgery. We were unable to determine any variable predictive of symptom resolution.

Topics: Abdominal Pain; Adult; Analysis of Variance; Biliary Dyskinesia; Cholecystectomy; Cholecystokinin; Cholelithiasis; Cohort Studies; Female; Gallbladder Diseases; Gallbladder Emptying; Humans; Male; Middle Aged; Probability; Prognosis; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Disofenin

Patients with biliary dyskinesia have symptoms consistent with biliary colic and an abnormal gallbladder ejection fraction (GEF) in the absence of cholelithiasis. Cholecystokinin hepatobiliary scan quantifies gallbladder function and may assist in selecting patients with acalculous biliary pain who would benefit from cholecystectomy. Seventy-eight patients with an abnormal GEF (< 35%) on cholecystokinin hepatobiliary scan without cholelithiasis were studied retrospectively. Patients were divided into groups based on diagnosis and treatment. In Group I, the patients who underwent cholecystectomy, 80 per cent (35 of 44) had complete symptomatic resolution whereas the remaining 20 per cent (9 of 44) had symptomatic improvement. Pathology reports demonstrated chronic cholecystitis in 95 per cent of specimens. Group II were patients with symptoms attributable to biliary dyskinesia, but did not undergo cholecystectomy. Persistence of symptoms was noted in 75 per cent (18 of 24) of patients whereas 25 per cent (6 of 24) had symptomatic resolution without any treatment. Group III consisted of patients with an abnormal ejection fraction who had improvement of symptoms after treatment for an alternative diagnosis (n = 10). These findings suggest that an abnormal ejection fraction does not always indicate gallbladder disease. Alternative diagnoses must be investigated and treated. Patients with persistent biliary type symptoms in combination with an abnormal GEF in the absence of other attributable causes can expect a favorable response to cholecystectomy.

Topics: Adult; Aged; Biliary Dyskinesia; Cholecystectomy; Cholecystokinin; Diagnosis, Differential; Female; Gallbladder Emptying; Humans; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Disofenin; Treatment Outcome

Topics: Animals; Biliary Dyskinesia; Biliary Tract Diseases; Cholecystokinin; Dogs; Gallbladder; Humans; Radionuclide Imaging; Reproducibility of Results; Sphincter of Oddi; Time Factors; Ultrasonography

The main aim of our study was the investigation of gallbladder motility prior to gallstone formation in vivo in guinea pigs fed a lithogenic diet. In a first experiment guinea pigs were fed a lithogenic diet for 5, 15, 30 and 45 days. First gallstones (pigment calculi) appeared after 30 days diet application. The in vitro contractility after lithogenic diet remained unchanged. In a second experimental part the in vivo gallbladder contractility was measured in two experimental animal groups (control group and 21 days lithogenic fed guinea pigs). The isovolumetric pressure rise inside the gallbladder following the intravenous injection of 10(-9) mol/kg body weight ceruletid was the essential contractility parameter (intraluminal basal pressure 5 mm hg). Due to lithogenic feeding of 21 days--that means prior to gallstone formation--the isovolumetric pressure rise was significantly elevated (p < 0.01). Moreover we observed passive distensibility changes of gallbladder muscle due to muscular hyperplasia. The main result of this investigation is the fact that gallbladder muscle in guinea pigs fed a lithogenic diet response to ceruletid application with hypercontractility prior to provable pigment gallstone formation. However gallbladder hypomotility--believed to be a causal factor in cholelithogenesis--was not observed in our experimental conditions.

Topics: Animals; Biliary Dyskinesia; Ceruletide; Cholecystokinin; Cholelithiasis; Cholesterol, Dietary; Disease Models, Animal; Female; Gallbladder Emptying; Guinea Pigs; Muscle Contraction; Muscle, Smooth

Standard biliary manometry, including cholecystokinin (CCK) provocation, was performed on 42 consecutive patients (36 F, 6 M, median age 45 years) with postcholecystectomy syndrome (PCS) who had no evidence of organic disease but who had objective clinical features suggesting sphincter of Oddi dysfunction (SOD) (classes I and II). Patients were subdivided into those with (N = 14) and without (N = 28) irritable bowel syndrome (IBS) using a validated symptom questionnaire based on the modified Rome criteria. Resting sphincter of Oddi (SO) motor parameters (basal pressure, contractile amplitude and frequency, and proportion of retrograde contractions), the presence of abnormal manometry, and the presence of an abnormal response to CCK were compared in the two groups. No significant differences in resting parameters of SO motor activity between patients with and without IBS were observed, and abnormal biliary manometry as a whole was not more prevalent in either group (8/13 and 18/27, respectively). An abnormal response to CCK (failure of complete inhibition of phasic contractions), however, was demonstrated in five of 12 patients with IBS compared with only one of 23 patients without IBS (P = 0.01). In patients with postcholecystectomy SOD, an abnormal response of the SO to CCK thus appears to be an important feature of the subset of patients with concomitant IBS.

Topics: Biliary Dyskinesia; Case-Control Studies; Cholecystokinin; Colonic Diseases, Functional; Female; Humans; Male; Manometry; Middle Aged; Postcholecystectomy Syndrome; Sphincter of Oddi

Between April 1, 1989, and January 1, 1994, 38 patients with chronic acalculous cholecystitis underwent an advanced (3-puncture) laparoscopic cholecystectomy at our institution. The 30 women and 8 men had a mean age of 39 years (range, 23 to 65 years) and represented 4.5% of our overall gallbladder patient population. In each case, the disease produced typical biliary colic, but no gallstones were visualized on ultrasound examination; cholecystokinin-stimulated cholescintigraphy revealed a dysfunctional gallbladder, as evidenced by an ejection fraction of < or = 35% or nonvisualization or nonemptying of the organ. In all 38 cases, cholecystectomy resulted in the complete relief of symptoms. Although an increasing number of physicians are recommending this operation for acalculous gallbladder disease, it should not be performed on the basis of clinical history alone. Rather, objective criteria confirming the need for surgical intervention should be obtained by means of appropriate preoperative testing, including cholecystokinin-stimulated cholescintigraphy.

Topics: Adult; Aged; Biliary Dyskinesia; Cholecystectomy, Laparoscopic; Cholecystitis; Cholecystokinin; Chronic Disease; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Technetium Tc 99m Lidofenin; Ultrasonography

The incidence of acute acalculous cholecystitis (AAC) is increasing and associated mortality is high. Biliary stasis and sludge formation are probably important factors in the pathogenesis of this disease. No data concerning the dynamics of these changes in the early phase of intensive care therapy are available. The gallbladders of 20 patients treated after major abdominal surgery in the surgical intensive care unit (SICU) with mechanical ventilation and without enteral feedings were therefore observed sonographically during the first 5 postoperative days in a prospective observational study. 20 patients treated on a regular ward after major abdominal surgery also not receiving any enteral nutrition served as control group. 24 hours after admission to the intensive care unit and on all subsequent days of observation the gallbladders of the patients in the SICU-group were significantly larger than in the control group. Sludge also appeared earlier and more frequently in the gallbladders of the SICU-patients. Lack of enteral feedings alone cannot explain these results. Positive-pressure ventilation and medications used in SICU are most likely responsible for the observed differences. Besides the necessity to make the diagnosis of AAC as early as possible, it appears to be worthwhile to investigate measures of prophylaxis. Since gallbladder distension in patients treated in SICU can be already observed on the first postoperative day it seems to be reasonable to initiate a regimen of prophylactic measures (e.g. with cholecystokinin or ceruletide) early in the course of ICU-therapy.

Topics: Abdomen; Acute Disease; Aged; Biliary Dyskinesia; Ceruletide; Cholecystitis; Cholecystokinin; Critical Care; Female; Humans; Male; Middle Aged; Parenteral Nutrition, Total; Positive-Pressure Respiration; Postoperative Complications; Prospective Studies; Risk Factors; Ultrasonography

One hundred eighty-seven patients who presented with symptoms consistent with biliary colic but had no ultrasonic evidence of cholelithiasis were observed in an effort to identify those with a functional gallbladder disorder that might benefit from surgical intervention. All patients underwent quantitative evaluation of gallbladder emptying using cholecystokinin biliary scanning, and ejection fractions less than 35% were considered abnormal. One hundred twenty-nine patients (69%) had abnormal ejection fractions, and 88 (68%) of these subsequently underwent cholecystectomy. Sixty of the surgical specimens revealed pathologic changes. Eighty-four percent of patients successfully contacted for follow-up experienced complete relief, and another 13% had partial relief of preoperative symptoms. Only two patients reported no change in symptom complex. Twenty-nine patients with abnormal ejection fractions elected not to undergo surgery. Fifty-nine percent of these patients continued to experience symptoms of biliary colic at a mean follow-up of 22 months. Of the 44 patients with normal ejection fractions, 35 (80%) reported resolution of symptoms during follow-up of medical treatment. Cholecystokinin biliary scanning can help identify patients with acalculous, functional gallbladder disease who may benefit from cholecystectomy.

Topics: Adult; Biliary Dyskinesia; Cholecystectomy; Cholecystitis; Cholecystokinin; Cholelithiasis; Diagnosis, Differential; Female; Follow-Up Studies; Gallbladder; Gallbladder Diseases; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Disofenin

In patients with upper abdominal complaints after cholecystectomy the normal and disordered bile flow was evaluated using quantitative scintigraphy after initially excluding organic etiology. A continuous intravenous infusion of cholecystokinin and secretin for one hour resulted in an accelerated bile flow in the majority of these patients, which is the normal reaction of the biliary system under stimulation. On the contrary, a bolus injection of these hormones led to marked delay of flow in a group of the study population, a condition taken as a paradoxical reaction to cholecystokinin. Although all of the patients with this paradoxical reaction did complain of typical biliary pain, a causal association is, however, yet to be proved. Nitrates can be helpful in the differential diagnosis of impeded bile flow, a lack of response being a possible sign of organic hindrance at the papilla of Vater.

Topics: Biliary Dyskinesia; Cholecystectomy; Cholecystokinin; Humans; Imino Acids; Nitroglycerin; Organotechnetium Compounds; Postoperative Complications; Radionuclide Imaging; Secretin; Technetium Tc 99m Diethyl-iminodiacetic Acid

To diagnose biliary dyskinesia (BD) in children, a method of urine alpha-amylase measurement is offered. It is based on the presence of a direct and close correlation between amylase activity and the amount of endogenous cholecystokinin-pancreozymin in the same portion of the urine. It is concluded that fractional measurement of urine alpha-amylase can be used for diagnosing BD in childhood as a tentative test. It is advisable that it may be used for examining younger children and in cases where the employment of other methods of examination is not feasible.

Topics: Adolescent; alpha-Amylases; Biliary Dyskinesia; Chemical Fractionation; Child; Child, Preschool; Cholecystokinin; Female; Humans; Male

Secretion of prostaglandins (Pg) E and F2 alpha in bile in basic condition (without stimulation) and under stimulation with cholecystokinin (CCK) ("Boots", England, 1 unit/kg) in patients with fatty liver with normal (15) and hypokinetic (20) function of gallbladder by radioimmunoassay method was investigated. The mediator role of Pg F2 alpha in the realization of effect of CCK on the contractile function of gallbladder was found. It was concluded, that the disturbance of mediator effect of Pg F2 alpha in the hormone regulation of bile excretion may play an important role in the pathogenesis of biliary dyskinesia. This disturbance of mediator effect of Pg was connected with the reducing of concentration and debit Pg F2 alpha in bile, as well as with the slowing of maximal Pg excretion under stimulation with CCK.

Topics: Bile; Biliary Dyskinesia; Cholecystokinin; Dinoprost; Fatty Liver; Gallbladder; Humans; Prostaglandins; Prostaglandins E; Radioimmunoassay

Three patients are presented with abnormal hepatobiliary images. A slow infusion of the terminal octapeptide of cholecystokinin caused asymmetric contraction in all three. Two of the patients displayed a bilobate appearance of the gallbladder. In one of the patients, there were typical changes associated with adenomyomatosis by other imaging modalities. The third patient showed good contraction of the fundus of the gallbladder but not of the proximal segment. In two of the patients, the global ejection fraction was considered to be normal. The asymmetrical contraction under the stimulus of cholecystokinin may be an important indicator of biliary dysfunction despite a normal ejection fraction.

Topics: Adolescent; Adult; Biliary Dyskinesia; Biliary Tract; Cholecystography; Cholecystokinin; Female; Gallbladder; Humans; Liver; Radionuclide Imaging; Ultrasonography

Sixty two patients with a clinical suspicion of biliary dyskinesia were investigated with endoscopic manometry of the sphincter of Oddi before and after intravenous injection of cholecystokinin or ceruletide. In 52 patients injection was followed by decreased pressure in the sphincter of Oddi; 43 of these had normal prestimulatory values (group I), while the values were raised in the other nine patients (group II). A paradoxical response to intravenous injection was observed in 10 women (group III): increased baseline sphincteric pressure occurred in eight and increase in the amplitude of phasic contractions in four patients. The prestimulatory sphincteric pressure was raised in five and normal in the remaining patients. Eight patients were treated with papillotomy (seven) or balloon dilatation of the sphincter (one). They experienced relief of pain during a follow up period of 11-16 months. Intravenous injection of cholecystokinin or ceruletide may disclose a special type of biliary dyskinesia even in patients with normal prestimulatory manometric findings. Hormone injection increases the diagnostic yield of endoscopic manometry in patients suspected of biliary dyskinesia.

Topics: Adult; Ampulla of Vater; Biliary Dyskinesia; Ceruletide; Cholecystokinin; Dilatation; Female; Humans; Male; Manometry; Middle Aged; Sphincter of Oddi

Gallbladder emptying was evaluated in 15 adult celiac disease patients by oral cholecystography or ultrasonography, after fatty meal or cholecystokinin stimulation. Gallbladder inertia was found in 13 cases. Our study agrees with previously reported results; however it is the first one in which this abnormality was demonstrated by ultrasonography. Our findings may suggest that gallbladder inertia is due to duodenal release of an inactive endogenous cholecystokinin. Control studies demonstrates that gallbladder inertia is reversible after gluten-free diet, recurs with relapse, and thus represents a true celiac disease sign, and not an associated condition. Finally, our cases suggest that gallbladder inertia may be radiologically evident before clinical features of malabsorption become apparent. Awareness of this possibility may persuade the radiologist to research in this condition an occult celiac disease.

Topics: Adult; Aged; Biliary Dyskinesia; Celiac Disease; Cholecystography; Cholecystokinin; Female; Gallbladder; Gallbladder Diseases; Humans; Male; Middle Aged; Ultrasonography

The cholescintigraphic findings of a Sphincter of Oddi dyskinesia (SOD) in a 45-year-old woman with persistent right upper quadrant pain and biliary colic are reported. After an overnight fast, the patient was injected with 5 mCi of Tc-99 disofenin and .02 micrograms/kg of cholecystokinin (CCK) post maximal gallbladder filling. Pre and postcholescintiscans were obtained and gallbladder ejection fractions determined. The hepatobiliary scan was normal, except for a delay in biliary-bowel transit. The gallbladder responded normally to CCK, however, the Sphincter of Oddi responded abnormally, as there was a paradoxical response to CCK manifested by a marked dilatation of the common bile duct. We postulate that this dilatation (the dilated common duct sign) was due to an inappropriate response of the smooth muscle of the Sphincter of Oddi (contraction vs relaxation) to CCK and was the cause of this patient's biliary colic. The dilated common duct sign should alert the physician to the possibility of a Sphincter of Oddi dyskinesia.

Topics: Ampulla of Vater; Biliary Dyskinesia; Cholecystokinin; Common Bile Duct; Dilatation, Pathologic; Female; Humans; Imino Acids; Middle Aged; Radionuclide Imaging; Sphincter of Oddi; Technetium; Technetium Tc 99m Disofenin

The paper concerns studying the participation of cyclic nucleotides in the mechanisms of action of cholecystokinin on gallbladder function in man. Cyclic nucleosides (cAMP and cGMP) were identified by radioimmunoassay in the duodenal contents obtained from men in response to intravenous injection of cholecystokinin. The data obtained suggest that the action of cholecystokinin on gallbladder function in man is mediated via cGMP, whereas cAMP is not implicated in the effect of of cholecystokinin on gallbladder function in man. Disturbances in cyclic nucleotide systems may be viewed in the light of the evidence obtained as a possible pathogenetic factor in the development of gallbladder dyskinesia.

Topics: Bile; Biliary Dyskinesia; Cholecystokinin; Cyclic AMP; Cyclic GMP; Fatty Liver; Humans; Liver; Time Factors

Because the efficacy of cholecystokinin cholecystography in the detection of chronic acalculous cholecystitis remains in doubt, the procedure is rarely used in clinical practice. However, the ability to observe gallbladder contraction with sonography and 99mTc-para-isopropylacetanilido-iminodiacetic acid cholescintigraphy (PIPIDA) offers a possibility to improve the sensitivity of the test. To determine if the degree of gallbladder contraction after cholecystokinin is the same as measured by the three techniques and if it differs in symptomatic patients compared to the normal population, cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA were performed in 10 symptomatic patients and 10 normal volunteers. The mean maximum contraction of the gallbladder during the three studies was 63%, 61%, and 68%, respectively, for the volunteers, and 72%, 63%, and 73%, respectively, for the patients. The mean maximum gallbladder contraction during all three procedures was 64% +/- 26% SD in the volunteers and 74% +/- 17% SD in the patients. The differences were not statistically significant. Although there was good correlation in the degree of maximum gallbladder contraction among cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA, marked variation in both the volunteers and the patients makes it unlikely that the degree of contraction as observed by any of these techniques can be used to indicate the presence of chronic acalculous cholecystitis.

Topics: Biliary Dyskinesia; Cholecystectomy; Cholecystitis; Cholecystography; Cholecystokinin; Follow-Up Studies; Gallbladder; Humans; Imino Acids; Muscle Contraction; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Ultrasonography

Biliary colic in the absence of demonstrable stones--and, indeed, in the absence of a gallbladder--has long been mystifying. Evidence is growing for the existence of purely functional disease of the biliary system. Although the mechanisms have not been fully elucidated, investigative procedures seem to provide a clinical basis for the diagnosis of biliary dyskinesia.

Topics: Ampulla of Vater; Animals; Biliary Dyskinesia; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Cholecystokinin; Humans; Muscle Contraction; Opossums; Pressure; Secretin

Topics: Adult; Biliary Dyskinesia; Cholangiography; Cholecystectomy; Cholecystokinin; Female; Follow-Up Studies; Humans; Male; Middle Aged

Topics: Biliary Dyskinesia; Cholangiography; Cholecystectomy; Cholecystokinin; Humans

Topics: Biliary Dyskinesia; Biliary Tract; Ceruletide; Cholecystokinin; Humans

The group of conditions variously termed biliary dyskinesia, acalculous cholecystitis, biliary pain without stones, or functional disorders of the biliary tract, is poorly defined clinically, and no consistent pathological abnormalities have been previously described in patients with this diagnosis. In this paper we report histological abnormalities encountered in operative live biopsies in such patients. The criteria for the diagnosis of a functional biliary tract disorders were: pain typical of biliary pain, negative results of investigations for organic biliary tract or other gastrointestinal disease, and reproduction of the patient's symptoms by cholecystokinin, or morphine, or both. Twenty of 45 patients with a presumptive diagnosis satisfied these criteria, and had a wedge liver biopsy at the time of operation. The 20 liver biopsy specimens were compared in a blind fashion with similar ones taken from patients having diagnostic laparotomies; patients with stones confined to the gallbladder; patients with gallstone pancreatitis; and patients with proven common bile duct stones. The biopsy findings were found to be similar to those in the latter two groups. Thus the abnormalities were similar to those found in partial or intermittent biliary obstruction, and it is suggested that they may be due to intermittent increases in biliary pressure.

Topics: Adult; Aged; Biliary Dyskinesia; Biliary Tract Diseases; Cholecystitis; Cholecystokinin; Cholelithiasis; Female; Humans; Liver; Male; Middle Aged; Morphine; Pain; Pancreatitis

Topics: Bile; Biliary Dyskinesia; Cholecystectomy; Cholecystography; Cholecystokinin; Cholelithiasis; Diagnosis, Differential; Gallbladder; Humans

Topics: Biliary Dyskinesia; Biliary Tract Diseases; Ceruletide; Cholangiography; Cholecystography; Cholecystokinin; Digestive System; Humans

Topics: Biliary Dyskinesia; Cholecystokinin; Humans

Topics: Adult; Biliary Dyskinesia; Cholecystitis; Cholecystography; Cholecystokinin; Cystic Duct; Female; Humans; Injections, Intravenous; Male; Methods; Middle Aged; Technology, Radiologic

Topics: Acetylcholine; Biliary Dyskinesia; Biliary Tract Diseases; Cholecystokinin; Duodenal Ulcer; Duodenum; Factor Analysis, Statistical; Gallbladder Diseases; Humans; Magnesium Sulfate; Manometry; Serotonin

Topics: Biliary Dyskinesia; Cholecystectomy; Cholecystitis; Cholecystokinin; Cholelithiasis; Gallbladder Diseases; Humans

Topics: Adult; Biliary Dyskinesia; Cholecystectomy; Cholecystography; Cholecystokinin; Humans; Injections, Intravenous; Male; Tissue Adhesions

Topics: Biliary Dyskinesia; Cholecystitis; Cholecystokinin; Duodenum; Fats; Gastrins; Gastritis; Gastrointestinal Motility; Hepatitis A; Humans; Stomach

Topics: Biliary Dyskinesia; Cholecystokinin; Cholelithiasis; Gallbladder Diseases; Gastrointestinal Diseases; Humans; Hypersensitivity; Muscle, Smooth; Radiography

Topics: Adult; Biliary Dyskinesia; Cholecystography; Cholecystokinin; Female; Humans; Male; Middle Aged

Topics: Ampulla of Vater; Amyl Nitrite; Atropine; Bile Ducts; Biliary Dyskinesia; Cholangiography; Cholecystokinin; Cineradiography; Dogs; Epinephrine; Iodipamide; Isoproterenol; Norepinephrine; Research; Sympathomimetics

Topics: Biliary Dyskinesia; Cholecystectomy; Cholecystokinin; Humans; Metabolism; Postoperative Complications; Sorbitol; Sympatholytics

Topics: Biliary Dyskinesia; Cholecystography; Cholecystokinin; Egg Yolk; Humans

Topics: Animals; Biliary Dyskinesia; Biological Assay; Cholangiography; Cholecystography; Cholecystokinin; Contrast Media; Gallbladder; Humans; Rabbits; Sorbitol

Topics: Ampulla of Vater; Biliary Dyskinesia; Cholangiography; Cholecystokinin; Common Bile Duct; Sphincterotomy, Transduodenal

Topics: Biliary Dyskinesia; Cholecystectomy; Cholecystography; Cholecystokinin; Cystic Duct; Gallbladder Diseases; Humans; Pathology

Topics: Animals; Biliary Dyskinesia; Cholangiography; Cholecystokinin; Cineradiography; Common Bile Duct; Dogs; Gallbladder; Guinea Pigs; Intubation; Intubation, Gastrointestinal; Pharmacology; Rabbits