GALLBLADDER DYSKINESIA IN ACALCULOUS BILIARY COLIC

Aims: To test the hypotheses that: 1) postprandial gallbladder emptyin g might be abnormal in patients with acalculous biliary colic; and 2) that hymecromone, a drug that increases bile flow and relaxes biliary muscle might improve symptoms, Methods: Twenty-four women were studied , Twelve patients presented recurrent biliary type of pain in the abse nce of gallstones, and persistence of contrast in the gallbladder, 24 hours after an oral cholecystogram, suggesting cholesterolosis. Twelve healthy volunteers used as controls had no symptoms and the gallbladd er was not visible the day after an oral cholecystogram, Gallbladder e mptying induced by an oral meal was studied with ultrasound in both gr oups before and after the administration of hymecromone. Results: Gall bladder volumes were similar in both groups (23 +/- 10 mi vs, 31 +/- 1 1 mi; NS), Gallbladder emptying in the control group was simple expone ntial (R(2) = 0.948 +/- 0.059) with a rate of 32 +/- 16 minutes, Gallb ladder emptying was bimodal in patients, Gallbladder volume increased to 120% in the first 10 minutes, to empty exponentially thereafter (R( 2) = 0.964 +/- 0.040, Rate: 29 +/- 22 minutes), This resulted in a mar ked reduction in gallbladder volume emptied at 40 minutes when compare d to controls (30% +/- 27% vs, 54% +/- 14%; p = 0.012), Pretreatment o f controls with hymecromone induced an emptying pattern similar to tha t of patients, In patients, emptying after hymecromone did not change but symptoms were improved, Conclusions: An abnormal emptying pattern of the gallbladder was identified in patients with acalculous biliary colic, and hymecromone was partly effective to reduce pain, despite a minor effect on gallbladder emptying pattern.