Gallbladder emptying and somatostatin and cholecystokinin plasma levels inceliac disease

OBJECTIVE: Gallbladder hypomotility in celiac disease has been attributed t o decreased cholecystokinin secretion. The possible influence of somatostat in, which inhibits gallbladder motility, however, has never been evaluated. In this study gallbladder emptying and cholecystokinin and somatostatin pl asma levels were evaluated in response to a fatty meal in patients with cel iac disease at diagnosis and after long-term gluten-free diet and in contro ls. METHODS: Gallbladder volume and plasma levels of cholecystokinin and somato statin were measured by ultrasonography and radioimmunoassay, respectively, at 0 time and 30, 60, 75, and 90 min after an oral fatty meal (227 kcal, 4 5% fat) in 10 celiac patients at diagnosis and after 18 months of successfu l gluten-free diet and in 10 healthy subjects. The pattern of gallbladder e mptying was evaluated by mixed factorial analysis of variance and the curve fitting by multiple regression analysis. RESULTS: Patients at diagnosis had significantly greater fasting gallbladde r volume and higher somatostatin plasma levels than controls (25.7 +/- SD 9 .7 ml vs 16.8 +/- 7.0 ml, p = 0.021 and 9.3 +/- 4.6 vs 4.8 +/- 3.4 pmol/L, p = 0.023, respectively), significantly lower fatty meal-induced gallbladde r ejection fraction (55 +/- 11.2% vs 76 +/- 7.2%, p = 0.005), and cholecyst okinin peak and smaller area under the cholecystokinin secretion curve (3.1 +/- 2.3 pmol/L vs 10.5 +/- 6.9 pmol/L, p = 0.028 and 157 +/- 142 pmol/L/90 min vs 453 +/- 229 pmol/L/90 min, p = 0.028, respectively). The two groups had a similar emptying pattern (p = 0.8913) expressed by a significant qua dratic term of the emptying function (p = 0.0001). The mean overall emptyin g volume was significantly greater in patients than in controls (p = 0.0007 ). Gluten-free diet normalized these findings. CONCLUSIONS: In patients at diagnosis, elevated somatostatin levels were as sociated with increased gallbladder fasting volume, whereas decreased chole cystokinin secretion was responsible for the reduced gallbladder emptying. Gluten-free diet reversed these abnormalities. (Am J Gastroenterol 1999;94: 1866-1870. (C) 1999 by Am. Coll. of Gastroenterology).