Gallbladder motility, gallstones, and the surgeon

Abstract

Cholecystectomy is one of the commonest surgical procedures in the Western world, with more than half a million procedures performed annually in the United States alone. In recent years, studies of gallstone pathogenesis and gallbladder disease have increasingly focused on abnormal gallbladder motility in the pathogenesis of some, if not all, gallbladder conditions. The control of gallbladder motility is complex and depends on an intricate interplay of neural and hormonal factors. An understanding of the control of gallbladder motility is crucial to the understanding of the mechanisms of gallstone formation and may help to explain the failure to cure symptoms after cholecystectomy in up to one third of patients. The purpose of this article is to outline mechanisms controlling gallbladder motility, examine recent developments in our understanding of this complex process, and relate changes in motility to common disease conditions of the gallbladder. The role of altered motility in the pathogenesis of gallstones is discussed and the effects of commonly performed surgical procedures such as truncal vagotomy and cholecystectomy on upper gut physiology are reviewed.

Increased Prevalence of Gallstone Disease and Impaired Gallbladder Motility in Patients with Barrett’s Esophagus

“…Among several other factors impaired gallbladder function could play a role in the development of gallstones [7]. In 2004, we extended the investigation with the ultrasonographic evaluation of the gallbladder function in our GERD patients.…”

Prevalência e fisiopatologia da litíase biliar em pacientes submetidos a transplante de órgãos

“…A secreção dessa bile pelo fígado não é a única condição necessária para formar cálculos, já que mais de 50% dos indivíduos normais secretam bile super-saturada em colesterol (bile litogênica) após uma noite de jejum 5 . Outras alterações, como estase e secreção de muco, parecem ser importantes na formação dos cálculos biliares 5,22 . Excesso de muco na vesícula biliar pode servir como núcleo para formação de cálculo biliar e a estase na vesícula biliar pode levar à cristalização.…”

Regulation and responses of gallbladder muscle activity in health and disease

“…15,34 Masclee et al 35 and van Erpecum et al 36 have shown reduced gall bladder emptying in some gallstone patients, together with increased fasting and residual gallbladder volumes. However, not all studies have concurred (for review, see Patankar et al 17 ) justifying further studies.…”

“…15,16 Situations in which gallbladder emptying is impaired predispose to gallstone formation. 17 We were, therefore, interested in determining the most appropriate methods for assessment of gallbladder emptying, and to investigate whether it was possible to promote gallbladder emptying by therapeutic manipulation.…”