Pediatric Gallbladder Dysmotility: Not as Rare as Previously Considered a Case Report and Review of Literature

Introduction: Chronic abdominal pain in children is mostly functional, but in association with alarm symptoms such as recurrent vomiting, it is necessary to determine proper tests for the diagnosis of probable underlying organic problems. Case Presentation: Four patients with chronic refractory abdominal pain and nonspecific gastrointestinal symptoms presented to our tertiary pediatric center. After thorough medical and psychological investigations and hepatobiliary scintigraphy, and calculating gallbladder ejection fraction, laparoscopic cholecystectomy was performed. One year after the surgery, they were relatively symptom-free and returned to their routine life. Conclusions: Biliary tract abnormalities should be considered as a probable cause of chronic abdominal pain in children. Hepatobiliary scintigraphy can provide promising results to help to identify the underlying causes of chronic abdominal pain in association with nonspecific gastrointestinal manifestations.

Outcomes After Laparoscopic Cholecystectomy in Hyperkinetic Biliary Dyskinesia

Background Biliary dyskinesia (BD) is a poorly understood functional gallbladder disorder. Diagnosis is made with abdominal pain and an intact gallbladder without signs of anatomical obstruction on imaging or pathology. Our aim was to assess whether laparoscopic cholecystectomy (LC) resolves hyperkinetic BD symptoms. Methods Records of patients ≥18 years of age, who underwent LC by four surgeons at a tertiary care center between 2012 and 2020, were retrospectively reviewed. Patients were excluded if they had a documented gallbladder ejection fraction (GBEF) <80% or had biliary stones or sludge on pathology or imaging. Demographic information, HIDA results, preoperative testing, operative details, gallbladder pathology, and symptom status at follow-up were collected from electronic medical records. Improvement in BD symptoms was assessed using McNemar’s test. Risk differences with standard errors were employed to estimate percent reduction in symptoms. Results Ninety-eight patients met inclusion criteria. Of those who presented for follow-up (n = 91), 92.3% (n = 84) reported partial or complete resolution of symptoms. Preoperative symptoms, including back pain (16.7%, 95% CI: [7.9%, 25.5%]; P < .0001), epigastric pain (31.1% [21.3%, 41.3%]; P < .0001), nausea (56.7% [45.0%, 65.8%]; P < .0001), RUQ pain (57.8% [46.1%, 66.9%]; P < .0001), and vomiting (27.8% [18.4%, 37.7%]; P < .0001) showed significant improvement after LC. Chronic cholecystitis and/or cholesterolosis were present on pathology in 79.8% of gallbladders. Discussion Our study currently represents the largest cohort of patients with hyperkinetic BD. Laparoscopic cholecystectomy appears to result in resolution of symptoms for this clinical entity.

Role of Cholecystectomy in Symptomatic Hyperkinetic Gallbladder Patients

Introduction. Biliary dyskinesia is defined by a gallbladder ejection fraction (EF) of less than 35% on HIDA scan, and these patients have shown a good response to cholecystectomy. Management of patients with biliary colic symptoms who have a hyperkinetic gallbladder ( EF > 80 % ) is not clearly defined. Herein, I report three cases of the symptomatic hyperkinetic gallbladder that were successfully managed with cholecystectomy. Case Report. Patient 1was a 56-year-old female presented with pain in the right upper abdomen for one month. Her workup was unremarkable except for the gallbladder EF of 86%. Patient 2 was a 33-year-old female with similar symptoms and workup with gallbladder EF of 97%. Patient 3 was a 20-year-old female with right upper abdominal pain and gallbladder EF of 91%. Patients 1 and 3 had the normal US, normal CT scan, and normal EGD. Patient 2 had normal US and CT but did not undergo EGD. All three patients underwent laparoscopic cholecystectomy and had complete resolution of their symptoms. Conclusion. The hyperkinetic gallbladder is a rare phenomenon, which can cause debilitating right upper quadrant pain. All three patients had an excellent response to cholecystectomy. Therefore, it is concluded that the patients with biliary colic and gallbladder EF of 80% or higher should be strongly considered for surgery.

Biliary Dyskinesia: Current Perspectives and Future Directions

Biliary dyskinesia (BD) is a disorder characterized by functional biliary pain, the absence of gallstones on ultrasound, and the finding of a reduced gallbladder ejection fraction on a cholecystokinin-cholescintigraphic scan. Cholecystectomy remains a commonly applied treatment for BD, despite a lack of high-quality evidence supporting the practice. The following article provides an overview of the current diagnostic strategies, treatment outcomes with both surgical and nonsurgical treatment, emerging considerations related to special populations, and suggestions for addressing the identified knowledge gaps, moving forward in an effort to develop stronger, more evidence-based practice guidelines for treating this poorly understood and poorly studied condition.

GALLBLADDER SIZES IN PATIENTS WITH ARTERIAL HYPERTENSION, OBESITY AND HYPOTHYROIDISM: CORRELATION ANALYSIS

Our previous studies showed that patients with arterial hypertension and excessive weight or obesity presented with the significantly enlarged gallbladder, both fasting and after taking cholekinetic. The gallbladder ejection fraction was below the normal range, and poor blood pressure control was accompanied by further gallbladder over distension, reduction of its contractility and increased risk of gallstone formation. This needs further research, especially considering hypothyreoidism. The aim is to establish correlations of the sonographically estimated gallbladder sizes in patients with arterial hypertension, obesity and hypothyreoidism. Materials and methods. The cohort of 40 patients (females 90%, males 10%) with arterial hypertension, body overweight/obesity and h underlying hypothyroidism was examined; sonographically estimated gallbladder sizes are compared with clinical, laboratory and instrumental data. Kendall's rank correlation method was applied; significance threshold was taken as р < 0,05. Results. In patients with arterial hypertension and overweight/obesity, the sizes of GB are enlarged both in cases of hypothyreoidism 64,4 mm (56–87) and 25 mm (21,2–28) and without it 67 mm (60–72) and 24 mm (22–29) with a significantly larger interquartile range (31 vs 12 mm) for hypothyroidism. According to Kendall's rank correlation analysis, gallbladder was enlarged in the older patients with a higher body mass index, and this statistically correlated with the advancement of stage and degree of arterial hypertension, cardiovascular risk, neutrophilic inflammation activation and immune inflammation suppression, thinned renal parenchyma, increased echogenicity of the pancreas, and cardioselective aspartataminotransferase cytolysis. These connections can be based on the common spinal innervation of the heart and gallbladder, dysregulated beta 3-adrenoceptor activity and disturbed nitrite mediated vasorelaxation. Keywords: gallbladder, size, arterial hypertension, hypothyroidism, obesity, cardiovascular risk.

GIP and GLP-1 Receptor Antagonism During a Meal in Healthy Individuals

Context The actions of both endogenous incretin hormones during a meal have not previously been characterized. Objective Using specific receptor antagonists, we investigated the individual and combined contributions of endogenous glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) to postprandial glucose metabolism, energy expenditure, and gallbladder motility. Design Randomized, double-blinded, placebo-controlled, crossover design. Setting On four separate days, four liquid mixed meal tests (1894 kJ) over 270 minutes (min). Patients or Other Participants Twelve healthy male volunteers. Interventions Infusions of the GIP receptor antagonist GIP(3–30)NH2 (800 pmol/kg/min), the GLP-1 receptor antagonist exendin(9–39)NH2 (0–20 min: 1000 pmol/kg/min; 20–270 min: 450 pmol/kg/min), GIP(3–30)NH2+exendin(9–39)NH2, or placebo/saline. Main Outcome Measure Baseline-subtracted area under the curve (bsAUC) of C-peptide. Results Infusion of GIP(3–30)NH2+exendin(9–39)NH2 significantly increased plasma glucose excursions (bsAUC: 261 ± 142 mmol/L × min) during the liquid mixed meals compared with GIP(3–30)NH2 (180 ± 141 mmol/L × min; P = 0.048), exendin(9–39)NH2 (171 ± 114 mmol/L × min; P = 0.046), and placebo (116 ± 154 mmol/L × min; P = 0.015). Correspondingly, C-peptide:glucose ratios during GIP(3–30)NH2+exendin(9–39)NH2 infusion were significantly lower than during GIP(3–30)NH2 (P = 0.0057), exendin(9–39)NH2 (P = 0.0038), and placebo infusion (P = 0.014). GIP(3–30)NH2 resulted in significantly lower AUCs for glucagon than exendin(9–39)NH2 (P = 0.0417). Gallbladder ejection fraction was higher during GIP(3–30)NH2 compared with placebo (P = 0.004). For all interventions, energy expenditure and respiratory quotient were similar. Conclusions Endogenous GIP and GLP-1 lower postprandial plasma glucose excursions and stimulate insulin secretion but only endogenous GIP affects gallbladder motility. The two incretin hormones potentiate each other’s effects in the control of postprandial glycemia in healthy men.