Gallbladder hyporesponsiveness to an exogenous nitric oxide donor, glyceryl trinitrate, in patients with advanced liver cirrhosis

OBJECTIVE: An increased production of nitric oxide (NO) in liver cirrhosis has been documented. NO could intervene in regulating gallbladder contracti on, as suggested by clinical and experimental studies. Our aim was to inves tigate the influence of an NO donor on gallbladder motility in cirrhotic pa tients in relation to the severity of liver cirrhosis. METHODS: The subjects were six controls and 18 patients with liver cirrhosi s (six in each Child class). Gallbladder emptying was monitored by ultrasou nd for 90 min after a mixed meal (14 g fat, 425 kcal). Fasting gallbladder volume, minimal residual volume, ejection fraction, area under emptying cur ve, and half contraction time of the gallbladder were assessed at 15-min in tervals. The patients were evaluated on two consecutive days, with or witho ut perlingual administration of 0.5 mg glyceryl trinitrate (GTN). Statistic al analysis was performed by the two-tailed Student's t test and Pearson's correlation coefficient. RESULTS: GTN significantly reduced gallbladder motility in controls and com pensated cirrhotics (p < 0.02), but had no effect upon gallbladder emptying in Child class B and C cirrhotics. CONCLUSIONS: Gallbladder hypocontractility in liver cirrhosis is related to the severity of the disease. This study is the first to show that GTN has no effect upon gallbladder motility in advanced liver cirrhosis when admini stered in doses that induce relaxation in controls and compensated cirrhosi s. (C) 1999 by Am. Coll. of Gastroenterology.