Gallbladder volume and emptying in diabetics: the role of neuropathy and obesity

Palasciano, Giuseppe; Portincasa, Piero; Belfiore, Anna; Baldassarre, Giuseppe; Cignarelli, Mauro; Paternostro, A.; Albano, O; Giorgino, R

doi:10.1111/j.1365-2796.1992.tb00512.x

Cited by 36 publications

(25 citation statements)

References 26 publications

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“…52 We thought it important to also study other potential fac-der motility defect. This finding has not been reported before and differs from the study of Berr et al 16 Fasting gallbladder tors that might contribute to gallstone recurrence after ESWL to exclude bias from these factors in terms of the rela-volume is frequently enlarged in obese persons, 60 …”

contrasting

confidence: 56%

Apolipoprotein E4 genotype and gallbladder motility influence speed of gallstone clearance and risk of recurrence after extracorporeal shock-wave lithotripsy

Portincasa¹,

Erpecum²,

Meeberg³

et al. 1996

Hepatology

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as well as a high risk of recurrence after ESWL. This Extracorporeal shock-wave lithotripsy (ESWL) is an finding points to a possible role for genetic factors in effective treatment in selected gallstone patients, but the pathogenesis of cholesterol gallstones. Effective gallstone recurrence is a major drawback. Factors potenbladder emptying is important for speed of clearance tially influencing gallstone clearance and recurrence and prevention of recurrence. Patients with initial soliwere studied in 84 patients in whom stone dissolution tary stones have a decreased early-but not long-term was diagnosed after ESWL plus bile salt therapy for inigallstone recurrence rate. (HEPATOLOGY 1996;24:580-tial solitary (n ! 55) or multiple (n ! 29) radiolucent 587.) stones. Apolipoprotein E (apoE) genotyping and gallbladder motility (sonography) were studied in a representative subgroup of patients (n ! 50). The median follow-up after ESWL was 36 months (range, 4.5-67 months).Extracorporeal shock-wave lithotripsy (ESWL) with adjuGallstone clearance was achieved after 8.7 months vant bile salt therapy to dissolve fragments is effective in (range, 0.2-30 months). Independent factors significantly selected patients with gallbladder stones. In the case of solienhancing gallstone clearance were the presence of E4 tary radiolucent gallstones with a diameter°20 mm, comallele; small initial gallstone size and number; effective-plete clearance can be expected in 70% to 80% of patients ness of fragmentation; and good gallbladder emptying after a year of treatment.1,2 Results, however, are consider-(P ! .002). Gallstone recurrence was seen in 30 patients ably less favorable for patients with larger or multiple gallafter 18.6 months (range, 1.0-50 months). Cumulative stones. A major drawback of nonsurgical therapy is the risk gallstone recurrence rate (life-table analysis) was 15% of gallstone recurrence after initially successful treatment. within 1 year, increasing to 60% within 5.5 years. Al-Previous studies on patients treated with oral bile salts sugthough the probability of gallstone recurrence tended gested a 50% recurrence rate at a 5-year follow-up with low or to be smaller in patients with initial solitary stones than no recurrence thereafter. 3,4 The fact that gallstone recurrence in those with multiple stones during early follow-up, dif-occurs in only one half of the patients suggests the existence ferences disappeared after long-term follow-up. Effec-of two subgroups of patients, one with a permanent and the tive gallbladder emptying (residual volume Ù6 mL) and other with a transient defect (e.g., pregnancy, oral contracepapolipoprotein E4 (apoE4) independently influenced tives, postmenopausal estrogens, weight loss in obese pagallstone recurrence. Recurrence rate was higher (log tients, and major abdominal surgery: all considered risk facrank test, P ! .037) in those patients who were homozy-tors for gallstone development). In particular, patients with gous and heterozygous for the E4 allele compared with initially multip...

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contrasting

confidence: 56%

Apolipoprotein E4 genotype and gallbladder motility influence speed of gallstone clearance and risk of recurrence after extracorporeal shock-wave lithotripsy

Portincasa¹,

Erpecum²,

Meeberg³

et al. 1996

Hepatology

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show abstract

“…The Finnish population, for example, differs from the Dutch population in apoE allele fre-number of initial gallstones. This finding has not been reported before and differs from the study of Berr et al 16 Fasting gallbladder tors that might contribute to gallstone recurrence after ESWL to exclude bias from these factors in terms of the rela-volume is frequently enlarged in obese persons, 60 21 Population differences might explain why apoE distribution in than onehalf of the cases.…”

Section: Discussioncontrasting

confidence: 53%

Apolipoprotein E4 genotype and gallbladder motility influence speed of gallstone clearance and risk of recurrence after extracorporeal shock-wave lithotripsy

Portincasa¹

1996

Hepatology

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Extracorporeal shock-wave lithotripsy (ESWL) is an effective treatment in selected gallstone patients, but stone recurrence is a major drawback. Factors potentially influencing gallstone clearance and recurrence were studied in 84 patients in whom stone dissolution was diagnosed after ESWL plus bile salt therapy for initial solitary (n = 55) or multiple (n = 29) radiolucent stones. Apolipoprotein E (apoE) genotyping and gallbladder motility (sonography) were studied in a representative subgroup of patients (n = 50). The median follow-up after ESWL was 36 months (range, 4.5-67 months). Gallstone clearance was achieved after 8.7 months (range, 0.2-30 months). Independent factors significantly enhancing gallstone clearance were the presence of E4 allele; small initial gallstone size and number; effectiveness of fragmentation; and good gallbladder emptying (P = .002). Gallstone recurrence was seen in 30 patients after 18.6 months (range, 1.0-50 months). Cumulative gallstone recurrence rate (life-table analysis) was 15% within 1 year, increasing to 60% within 5.5 years. Although the probability of gallstone recurrence tended to be smaller in patients with initial solitary stones than in those with multiple stones during early follow-up, differences disappeared after long-term follow-up. Effective gallbladder emptying (residual volume < or = 6 mL) and apolipoprotein E4 (apoE4) independently influenced gallstone recurrence. Recurrence rate was higher (log rank test, P = .037) in those patients who were homozygous and heterozygous for the E4 allele compared with the individuals who were not expressing the apoE4 allele. Accordingly, there was an overrepresentation of the allele frequency for E4 in the group with gallstone recurrence (P =.03). Patients with small postprandial residual gallbladder volumes (

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“…5 Involvement of gall bladder in diabetic autonomic neuropathy is usually manifested in the form of higher incidence of gall stones and a significant increase in gall bladder volume 6 with poor concentration and poor visualization, with lack of symptoms of gallbladder disease. 7 The present study has aim to find out the prevalence of gallbladder diseases in patients of type 2 chronic diabetes, correlation in duration of diabetes with gall bladder disease and comparison of gallbladder dysfunction in patients with and without autonomic neuropathy as well as normal individuals.…”

mentioning

confidence: 99%

Gall bladder dysfunction in chronic diabetics (type 2): an ultrasonography based prospective study

Garjesh¹,

Baghel²,

Rai³

et al. 2016

Int J Res Med Sci

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Gallbladder volume and emptying in diabetics: the role of neuropathy and obesity

Cited by 36 publications

References 26 publications

Apolipoprotein E4 genotype and gallbladder motility influence speed of gallstone clearance and risk of recurrence after extracorporeal shock-wave lithotripsy

Apolipoprotein E4 genotype and gallbladder motility influence speed of gallstone clearance and risk of recurrence after extracorporeal shock-wave lithotripsy

Apolipoprotein E4 genotype and gallbladder motility influence speed of gallstone clearance and risk of recurrence after extracorporeal shock-wave lithotripsy

Gall bladder dysfunction in chronic diabetics (type 2): an ultrasonography based prospective study

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