COMMON PATHOGENETIC MECHANISMS IN SYMPTOMATIC, UNCOMPLICATED GALLSTONE DISEASE AND FUNCTIONAL DYSPEPSIA - VOLUME MEASUREMENT OF GALLBLADDERAND ANTRUM USING 3-DIMENSIONAL ULTRASONOGRAPHY

Following cholecystectomy for uncomplicated gallstone disease (GS) som e patients experience persistent symptoms suggesting an underlying fun ctional disorder. To study this phenomenon, we have compared symptomat ic GS with functional dyspepsia (FD) patients and healthy individuals (C) with respect to putative pathogenetic mechanisms. Gallbladder and gastric antrum volumes were estimated with three-dimensional (3D) ultr asonography before and 10 min after ingestion of 500 ml meat soup in 1 8 patients with GS. Volume estimation was performed digitally after in teractive manual tracing and organ reconstruction, in three dimensions . Respiratory sinus arrhythmia (RSA) was calculated to index vagal ton e. Abdominal symptoms were assessed by interview. The results were com pared to previously published data in patients with FD and C investiga ted with the exact same methods. No significant differences were found between groups with respect to fasting gallbladder or gallbladder emp tying. Antral volumes both fasting (P < 0.05) and postprandially (P < 0.01) were larger in GS and FD than in C. The soup meal induced dyspep tic symptoms in 2/18 (11%) of C, 12/18 (67%) of GS and 15/17 (88%) of FD patients (P < 0.001). Compared with C, both GS and FD patients had significantly decreased vagal tone (P < 0.001). There was no significa nt difference between GS and FD patients with respect to antral volume , vagal tone, or symptoms. We concluded that both gallstone and functi onal dyspepsia patients are characterized by dyspeptic symptoms in res ponse to ingestion of 500 ml of meat soup, a wide gastric antrum, low vagal tone, but normal gallbladder size and emptying. Thus, patients w ith symptomatic, uncomplicated gallstone disease and functional dyspep sia seem to have common pathogenetic mechanisms.