motilin and Cholelithiasis

Topics: Adenoma, Islet Cell; Chenodeoxycholic Acid; Cholecystokinin; Cholelithiasis; Dehydration; Diabetes Mellitus; Duodenal Ulcer; Gastric Inhibitory Polypeptide; Gastrins; Gastrointestinal Hormones; Humans; Motilin; Pancreatic Neoplasms; Secretin; Syndrome; Vasoactive Intestinal Peptide; Zollinger-Ellison Syndrome

To establish the role of the main risk factors and endocrine cells of the antrum of the stomach producing motilin (M-cells) in the occurrence of cholelithiasis.. The first group included 122 patients with cholelithiasis. The second group consisted of 30 healthy individuals who underwent medical examination. The groups were matched for gender and age. The work analyzed anamnestic, biochemical and anthropometric data. All patients underwent esophagogastroduodenoscopy with targeted biopsy of the mucous membrane from the antrum. Biopsies were subjected to cytological and immunohistochemical studies in order to verify Helicobacter pylori and estimate the number of M-cells.. Patients with cholelithiasis more often belonged to the group of people of mental labor, had low physical activity, were committed to inappropriate nutrition and more often indicated the presence of aggravated heredity for cholelithiasis. Patients with gallstone disease had higher body mass index, waist volume, total cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, lower high-density lipoprotein cholesterol, H. pylori infection was more often verified and M-cell hypoplasia in the mucous membrane was established. stomach in comparison with the representatives of the second group.. Our results suggest that certain external factors, nutritional characteristics of the metabolic syndrome components, hypoplasia of M-cells in the gastric mucosa are important factors in the formation of calculi in the gallbladder.. Цель. Установить роль основных факторов риска и эндокринных клеток антрального отдела желудка, продуцирующих мотилин (М-клетки), в возникновении желчнокаменной болезни (ЖКБ). Материалы и методы. В 1-ю группу включены 122 пациента с ЖКБ; 2-ю группу составили 30 здоровых лиц, прошедших диспансеризацию. Группы сопоставимы по полу и возрасту. В работе анализировались анамнестические, биохимические и антропометрические данные. Всем пациентам выполнялась эзофагогастродуоденоскопия с прицельной биопсией слизистой оболочки из антрального отдела желудка. Биоптаты подвергнуты цитологическому и иммуногистохимическому исследованию с целью верификации Helicobacter pylori и оценки количества М-клеток. Результаты. Пациенты с ЖКБ чаще относились к группе лиц умственного труда, имели низкую физическую активность, оказались привержены нерациональному питанию и чаще указывали на наличие отягощенной наследственности по ЖКБ. У пациентов с ЖКБ отмечались более высокие показатели индекса массы тела, объема талии, уровня общего холестерина (ХС), ХС липопротеидов низкой плотности, триглицеридов, глюкозы, более низкий уровень ХС липопротеидов высокой плотности, чаще верифицировалась инфекция H. pylori и установлена гипоплазия М-клеток в слизистой оболочке желудка по сравнению с представителями 2-й группы. Заключение. Полученные нами результаты дают основание сделать вывод о том, что определенные внешние факторы, особенности питания, компоненты метаболического синдрома, гипоплазия М-клеток в слизистой оболочке желудка являются важными факторами формирования конкрементов в желчном пузыре.

Topics: Cholelithiasis; Cholesterol; Endocrine Cells; Gastric Mucosa; Glucose; Helicobacter Infections; Helicobacter pylori; Humans; Lipoproteins, HDL; Lipoproteins, LDL; Motilin; Risk Factors; Stomach; Triglycerides

To investigate the relationship between anatomic abnormalities and malfunction of Oddi sphincter with formation of bile duct pigment gallstone.. One hundred and twenty-three patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group by measuring the amounts of radioactivity of (99m)Tc-DTPA in the bile. Among them 53 were selected randomly to undergo choledochoscopic manometry. Basal pressure of Oddi's sphincter (SOBP), amplitude of Oddi's sphincter (SOCA), frequency of contraction (SOF), duration of contraction (SOD), duodenal pressure (DP), common bile duct pressure (CBDP) were scored and analyzed. The level of plasma motilin and serum gastrin of 45 patients and 12 healthy volunteers were measured by radioimmunoassay. The incidence rates of duodenal descending part diverticulum in patients with bile duct pigment stones, patients without alimentary tract diseases, patients with gallbladder polyps, patients with gallbladder stones were studied by means of barium meal examination. The incidence rates of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stones, patients with bile duct stone and gallbladder stones, patients with bile duct stones originating from the gallbladder, patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla, patients with post-cholecystectomy syndrome were detected by duodenoscope.. Of the patients, 44 were detected with duodenal-biliary reflux (35.8%). SOBP, SOCA and CBDP in the reflux group were much lower than those in control group (P < 0.001). The level of serum gastrin and plasma motilin of the reflux group were much lower than those of control group (P < 0.01). Positive correlation was found between level of motilin and SOBP while level of gastrin was positively correlated with SOBP and CBDP. The incidence of duodenal diverticulum in patients with bile duct pigment stone was 36.62%, which was higher than that of the other 3 groups. The incidence rate of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stone was higher than that of patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla and patients with bile duct stones originating from the gallbladder.. The patients with bile duct pigment stone have apparent duodenal-biliary reflux and infection of the bile duct. The state of structure and function of Oddi's sphincter is correlated significantly with bile duct pigment stone. The anatomic abnormalities and malfunction of Oddi's sphincter played an important role in the formation of bile duct pigment stone.

Topics: Adult; Aged; Aged, 80 and over; Bile Pigments; Cholelithiasis; Female; Gastrins; Humans; Male; Middle Aged; Motilin; Pressure; Radioimmunoassay; Retrospective Studies; Sphincter of Oddi

The aim of the study was to determine the clinical significance of intestinal functional and structural alterations in biliary pathology. Clinical, endoscopic, morphological, and morphometric methods were used. The subjects of the study were 62 patients with functional gall bladder disorder, 90 patients with chronic calculous cholecystitis, and 90 patients who had undergone cholecystectomy for cholelithiasis. The study found that biliary lithogenesis was associated with intestinal dysbiosis, changes in the qualitative density of erythrocytes immunopositive to motilin and substance P, and inflammatory changes in the intestines. After cholecystectomy, changes in intestinal microecology progressed, inflammatory and atrophic changes in the intestinal mucosa appeared or deepened, the qualitative density of erythrocytes immunopositive to motilin and substance P decreased, and colon polyps appeared more frequently.

Topics: Adult; Aged; Atrophy; Cholecystitis; Cholelithiasis; Chronic Disease; Colonic Polyps; Diagnosis, Differential; Erythrocyte Count; Erythrocytes; Female; Humans; Inflammation; Intestinal Mucosa; Male; Middle Aged; Motilin; Predictive Value of Tests; Prognosis; Substance P

The role of interdigestive gallbladder emptying in gallstone formation is unknown. In fasting healthy subjects, gallbladder emptying is associated with antral phase III of the migrating motor complex (MMC) and high plasma motilin. Therefore, gallbladder volumes and motilin levels were measured during 13 MMC cycles in 10 cholesterol gallstone patients and compared with 20 MMC cycles in 10 healthy subjects. MMC cycle length was longer in gallstone patients than in healthy subjects (158.2 +/- 17.0 vs 105.5 +/- 10.4 min, respectively; P < 0.05), due to longer phase I (39.8 +/- 5.7 vs 17.2 +/- 3.7 min, respectively; P < 0.05). In contrast to healthy subjects, gallstone patients had no significant fluctuations of gallbladder volume during the MMC cycle, and motilin concentrations were not different in MMC cycles with phase III originating in antrum or duodenum. During MMC cycles with phase III originating in the duodenum, motilin levels were twice as high in gallstone patients as in healthy subjects (P < 0.002). In conclusion, cholesterol gallstone patients have an abnormal MMC and motilin release pattern. Their interdigestive gallbladder emptying is reduced and dissociated from the MMC. These disturbances may contribute to gallstone formation.

Topics: Cholelithiasis; Cholesterol; Digestion; Duodenum; Female; Gallbladder Emptying; Gastrointestinal Motility; Humans; Male; Middle Aged; Motilin; Pyloric Antrum

Sufficient gallbladder emptying accelerates early gallstone clearance after extracorporeal shock wave lithotripsy (ESWL). Litholytic therapy with ursodeoxycholic acid (UDC) subsequent to ESWL increases fasting volume (FV) and postprandial residual volume (RV) of the gallbladder. This may lead to retention of cholesterol crystals and small fragments within the gallbladder. In order to find out whether erythromycin, a motilin agonist, improves gallbladder emptying, we tested gallbladder motility after administration of ursodeoxycholic acid with and without oral application of erythromycin. Ten healthy males (age 26-35 years) obtained 10 mg/kg/d of UDCA as a single bedtime dose for three weeks. Prior and after UDCA administration, gallbladder FV was determined sonographically after overnight fasting. After a test meal (490 kcal), gallbladder volume was measured every 5 min until the gallbladder had reached its minimal RV. The next day the same procedure was repeated with 500 mg erythromycin p.o. 45 min prior to test meal application. FV, RV, ejection volume (EV = FV-RV) and ejection fraction (EF = EV/FV x 100) were calculated and differences were compared by the student's t-test. FV (29 ml +/- 8 ml vs. 38 ml +/- 10 ml), RV (12 ml +/- 6 ml vs. 17 ml +/- 6 ml) and EV (17 ml +/- 5 ml vs. 21 ml +/- 6 ml) increased significantly during therapy with UDCA (p < 0.05). EF did not change significantly. After erythromycin application RV decreased to its original values (13 ml +/- 6 ml), whereas EV (24 ml +/- 6 ml) and EF (58% +/- 9% vs. 66% +/- 11%) increased significantly (p < 0.05). Thus, administration of a motilin agonist blunts unwanted effects on gallbladder motility during litholytic therapy with UDC.

Topics: Administration, Oral; Adult; Cholagogues and Choleretics; Cholelithiasis; Combined Modality Therapy; Drug Synergism; Erythromycin; Gallbladder Emptying; Humans; Lithotripsy; Male; Motilin; Postprandial Period; Reference Values; Ursodeoxycholic Acid

Gallstone formation is frequently seen following gastric surgery. Since dysmotility and bile stasis of the gallbladder is considered as an important factor in the pathogenesis of gallstone formation, altered gallbladder motility due to gastric surgery may have a role in the development of post-gastrectomy gallstone formation. To test this hypothesis, the effect of distal partial gastrectomy on gallbladder motility were studied. Gastroduodenal and gallbladder contractions were recorded by chronically implanted strain gauge transducers under conscious state. Gallbladder volume changes were monitored using chronically indwelling gallbladder catheter. Fasted and fed motility were studied in control (n = 5) and gastrectomized (n = 3) dogs. Plasma concentration of putative hormone CCK was measured. Effect of CCK-OP and motilin on gallbladder emptying were also studied. In fasted state, gallbladder volume was periodically decreased synchronous with phase 3 of interdigestive migrating contractions (IMC) in the gastroduodenum in both group of dogs. The correlation between gastric and gallbladder contractions was preserved even following distal partial gastrectomy, though the frequency of phasic contractions during phase 3 of IMC was decreased in the gastrectomized dogs. Postprandial gallbladder emptying tend to decreased in the gastrectomized dogs, while there were no difference in the postprandial plasma CCK concentrations and CCK-OP induced gallbladder emptying between groups. Digestive period was shortened in the gastrectomized dogs, which resulted in early gallbladder refilling and prolonged interdigestive period. Decreased frequency of gallbladder phasic contractions during IMC and prolonged interdigestive period could cause bile stasis in the gallbladder, which may, in part, explain post-gastrectomy gallbladder formation.

Topics: Animals; Cholecystokinin; Cholelithiasis; Dogs; Gallbladder Emptying; Gastrectomy; Motilin

Topics: Cholelithiasis; Erythromycin; Gallbladder; Gallbladder Emptying; Humans; Motilin

Data about gallbladder motility in stone disease and stone free conditions are discussed controversially. This study is aimed at to evaluate in vitro the responses of human gallbladder muscle stripes to cholecystokinin, motilin and neurotensin. Following the results, a stratification of the "stone-disease-group" seems to be necessary: 41% of the gallbladders (stone disease) demonstrate a deep reduction in contractility to cholecystokinin ("non-contractors"), whereas 59% of the gallbladders contract in the same pattern like the controls ("contractors"). Interestingly, the majority of the gallbladders in the "contractor" group demonstrate a high spontaneous activity which is absent in stone free gallbladders. Motilin and neurotensin either do not induce any effect.

Topics: Adult; Aged; Aged, 80 and over; Cholecystokinin; Cholelithiasis; Dose-Response Relationship, Drug; Female; Gallbladder; Humans; In Vitro Techniques; Male; Middle Aged; Models, Biological; Motilin; Muscle Contraction; Muscle, Smooth; Neurotensin; Peristalsis

Plasma motilin concentrations were measured in eight controls and 11 patients with radiolucent gallstones over a period of 3-4 h following an overnight fast. In five of these patients the interdigestive motor complex (IDMC) was studied simultaneously. The results indicate: a) cyclical changes of plasma motilin concentrations (mean cycle duration 110 +/- 9.9 and 102 +/- 8.4 min, means +/- SEM) and a significant correlation between the basal intercyclical motilin concentrations and the age (p less than 0.02) in the controls and the gallstone patients studied, and b) a significant correlation between the maximal motilin increase and the age in the controls (p less than 0.01) but not in the gallstone patients. The results therefore suggest a different behaviour of the interdigestive motilin patterns in controls and gallstone patients. As the motilin cycles were accompanied in 90% with an IDMC in the five patients studied this conclusion might include an abnormal interdigestive motor activity within the intestinal tract in gallstone patients.

Topics: Cholelithiasis; Digestive System; Enterohepatic Circulation; Female; Gastrointestinal Hormones; Gastrointestinal Motility; Humans; Male; Motilin

Plasma motilin levels were measured by radioimmunoassay both pre- and postoperatively in 37 patients who underwent abdominal surgery. In 8 colorectal cancer patients with tumor removal and in 13 stomach cancer patients with total gastrectomy by Roux-en-Y anastomosis or subtotal gastrectomy of Billroth I anastomosis, the motilin levels decreased before the onset of postoperative peristalsis, and at the time when peristaltic sounds could be detected stethoscopically, the plasma motilin levels had increased by 200% of the preoperative level. Similar motilin levels were maintained until the time of the initial postoperative flatus and/or stool. Thereafter, plasma motilin levels decreased and returned to almost the same levels as the preoperative ones. The postoperative time course of plasma motilin in 10 gallstone patients was very similar to that in the 21 gastrointestinal cancer patients above. In 5 stomach cancer patients with subtotal gastrectomy of Billroth II anastomosis, however, the peak at the time of the initial postoperative peristalsis was not as remarkable as that in the 13 stomach cancer patients.

Topics: Adult; Aged; Cholelithiasis; Colonic Neoplasms; Female; Gastrectomy; Gastrointestinal Diseases; Gastrointestinal Hormones; Humans; Male; Middle Aged; Motilin; Peristalsis; Radioimmunoassay; Rectal Neoplasms; Stomach Neoplasms