GALLBLADDER SENSITIVITY TO CCK IN DUODENAL-ULCER DISEASE, HIGHLY SELECTIVE AND TRUNCAL VAGOTOMY

Background/Aims: Following truncal vagotomy, a heightened contractile response of the gallbladder to cholecystokinin (CCK) has been reported in patients. We investigated whether the gallbladder responsiveness t o the CCK analog cerulein is also affected in patients with a highly s elective vagotomy (HSV) and in duodenal ulcer patients, since most pat ients had truncal vagotomy for recurrent peptic ulcer disease. Materia ls and Methods: Gallbladder emptying (cholescintigraphy) and plasma ch olecystokinin like immunoreactivity (CCK-LI) levels were studied durin g infusion of graded doses of the CCK analog cerulein. Results: In duo denal ulcer patients (n=9), patients with HSV (n=9), patients with tru ncal vagotomy (n=9) and control subjects (n=9) infusion of stepwise in creasing doses of cerulein (1-16 ng.kg(-1).h(-1)) induced dose related changes in plasma CCK-LI. In patients with truncal vagotomy, the gall bladder contraction in response to 1, 2 and 4 ng.hg(-1).h(-1) of cerul ein was significantly increased over controls; whereas the gallbladder contraction to cerulein in duodenal ulcer patients and patients with HSV was not significantly different fi om controls. Conclusions: Thus, in, patients with truncal vagotomy, the gallbladder contractile respo nse to CCK is significantly enhanced, possibly due to denervation of h epatic vagal branches since gallbladder contraction after CCK infusion shows no difference between post HSV or duodenal ulcer patients and t he controls.