EFFECT OF PREDIGESTED FAT ON INTESTINAL STIMULATION OF PLASMA CHOLECYSTOKININ AND GALL-BLADDER MOTILITY IN CELIAC-DISEASE

Cholecystokinin (CCK) release and gall bladder emptying in response to a fatty meal are completely abolished in coeliac disease. To determin e the effect of Lipid digestion on CCK release and gall bladder motili ty, six patients with untreated coeliac disease and a flat jejunal muc osa were studied on two separate days. After an overnight fast, the pl asma CCK concentration and gall bladder volume were measured before an d at regular intervals after the intraduodenal instillation of 60 ml c orn oil (triglycerides) incubated with 40 ml saline or with 40 ml bile and pancreatic juice. The mean (SEM) concentration of free fatty acid s in the aqueous phase of corn oil after incubation with bile and panc reatic juice (predigested corn oil) was 78 (35) mM compared with 0.1 ( 0.1) mM in the aqueous phase of corn oil incubated with saline (undige sted corn oil). Integrated plasma CCK in response to predigested corn oil was significantly greater than that in response to undigested corn oil (101 (18) pM. 80 min v -2 (9) pM.80 min; p<0.005). Similarly, int egrated gall bladder contraction in response to predigested corn oil w as significantly larger than that after undigested corn oil (817 (210) ml. 80 min v -225 (243) ml. 80 min; p<0.05). In contrast to undigeste d corn oil, corn oil that has been predigested with bile and pancreati c juice induces plasma CCK secretion and gall bladder contraction in p atients with untreated coeliac disease, presumably by generating and r endering soluble lipolytic products.