Neurohormonal Aspects of Gallbladder Contractility in Gallstone Disease: The Role of Cholecystokinin

Influence of Ceruletid on Gallbladder Contraction: A Possible Prophylaxis of Acute Acalculous Cholecystitis in Intensive Care Patients?

“…For example, one study measured smallest gallbladder vol umes 5-15 min after application of CKK, yet another after 20 min [14,32], In healthy subjects, it takes 40-120 min until the initial volume is reached again [34], This time was determined with 60 min in intensive care patients who had been mechanically ventilated for 7 days and had under gone laparotomy [14], However, ceruletid reduced gall bladder volume as well as quantity of sludge at very low doses, much lower than the effective dose of 1.5 pg Takus per kg body weight that we have determined. This has also been shown in other studies and confirms our results [5,[13][14][15]. Although distribution of age and sex of the patients in this study was largely homogeneous, the cases were not uniform and basic treatment differed accordingly.…”

“…The amount of sludge after 3 days of intensive care that we found in this study compares well to the literature [13,22,36], Our data clearly show that Takus, when given in a dose of > 1.0 qg/kg body weight, always results in a 25% reduction of sludge and doses of 1.5 pg/kg body weight may even reduce sludge by half in some cases. Thus, ceruletid is effective in reducing both, size of gallbladder as well as proportion of sludge in critically ill patients on surgical intensive care units.…”

“…The initial gallbladder volume after 3 days of mechani cal ventilation, immobilization and TPN prior to the administration ofTakus observed by us at 32.2 ± 9 cm3 is in the upper range of comparable studies [13,14,32,33,36], The times at which the medication took effect (20 min after intravenous injection ofTakus) and the period within which the gallbladder returned to its initial volume (120 min after application ofTakus) match the data in the literature [14, 32], Klueppelberg et al [13] described such patients as 'contractors', in contrast to the group o f 'non contractors' in whom less or no gallbladder contractions after CKK administration was observed. The different responses to CKK may be due to interindividual differ ences in the number of biliary CKK receptors, which may be limiting to the applicability of the drug [37].…”

“…At the gallbladder, the indirect effect is based on binding of ceruletid to cholecystokinin receptors and a subsequent increase in acetylcholine release initiating smooth muscle contraction. Mediated by its direct effect as a neurotransmitter, application of ceruletid results in gall bladder contraction together with simultaneous relaxation of the spincter of Oddi [11][12][13][16][17][18].…”

“…Ceruletid causes gall bladder contraction and dilatation of the sphincter of Oddi [11,12] and has been used in intensive care patients to stimulate biliary motility. However, reports in the liter ature regarding the effectiveness of ceruletid analogs on gallbladder contraction in mechanically ventilated pa tients on TPN are contradictory [13][14][15].…”