Gall bladder emptying in severe idiopathic constipation

Background-It has been suggested that slow transit constipation (STC) may b e part of a panenteric motor disorder. Aim-To evaluate motility of an upper gastrointestinal organ, the gall bladd er, in 16 patients with STC and 20 healthy controls. Methods-Gall bladder emptying (ultrasonography) was studied in response to neural, cephalic-vagal stimulation with modified sham feeding (MSF) for 90 minutes and in response to hormonal stimulation with cholecystokinin (CCK, 0.5 IDU/kg/h) for 60 minutes. Results-Fasting gall bladder volume in patients with STC (17 (2) cm(3)) was significantly (p<0.01) reduced compared with that in controls (24 (2) cm(3 )). Gall bladder emptying in response to MSF was significantly reduced in p atients with STC expressed both as percentage emptying (11 (5)% versus 22 ( 3)%; p<0.05) and as absolute emptying (2.1 (0.7) cm(3) versus 4.9 (0.7) cm( 3); p<0.02). However, percentage gall bladder emptying in response to CCK w as not different between patients and controls (73 (4)% versus 67 (4)%) alt hough the absolute reduction in gall bladder volume was significantly (p<0. 05) smaller in patients (10.7 (1.1) cm(3) versus 15.3 (1.4) cm(3)). Conclusions-Patients with slow transit constipation have smaller fasting ga ll bladder volumes, impaired gall bladder responses to vagal cholinergic st imulation, but normal gall bladder responses to hormonal stimulation with C CK. These results point to abnormalities in gastrointestinal motility proxi mal from the colon in slow transit constipation and more specifically, impa ired neural responsiveness.