In vitro responses of gallbladder muscle from patients with acalculous biliary pain

Background: Diagnosis and identification of patients with acalculous biliar y pain, who would benefit from surgery, remains a significant clinical prob lem. The cholecystokinin (CCK) provocation test helps diagnosis, but lack o f consistency limits its usefulness. Aim: To characterize the response of g allbladder muscle strips, from patients with acalculous biliary pain, to ho rmonal and muscarinic stimulation and to compare these with strips from gal lstone patients and normal controls. Patients: Eleven patients with acalcul ous biliary pain were studied, 5 had a positive CCK test. Eight gallbladder s from gallstone patients and 6 from partial hepatectomies were used for co mparison. Methods: Muscle strips from the body and neck of the gallbladder were suspended in organ baths and dose-response curves were constructed for CCK-8 and carbachol. Results: In the acalculous group the strips from the body were less sensitive to carbachol than those of the neck. Conclusion: S ince we found no differences in the CCK responses for the groups, it casts doubt over the effectiveness of the CCK test to diagnose acalculous biliary pain. Since carbachol sensitivity was different, it might be that a simila r test using muscarinic stimulation would help in the diagnosis of this dif ficult group of patients. Copyright (C) 2000 S. Karger AG, Basel.