Sludge and stone formation in the gallbladder in bedridden elderly patients with cerebrovascular disease: influence of feeding method

Purpose. The incidence of gallbladder sludge or gallstone formation in bedr idden patients with cerebrovascular disease (CVD) remains obscure. The aim of this study was to determine the incidence, relationship to feeding metho d, and mechanisms of gallbladder sludge and gallstone formation in elderly patients with CVD. Methods. Using ultrasonography, we determined the develo pment of gallbladder sludge and gallstone over a 12-month period, the area of the gallbladder, the gallbladder contractile response to cerulein, and f asting levels of plasma cholecystokinin (CCK) in 40 bedridden elderly patie nts with CVD. The patients were divided into three groups based on the feed ing method: oral ingestion (OI), nasogastric feeding (NF), and total parent eral nutrition (TPN). Results. Gallbladder sludge and gallstone were not ob served in any of the 14 OI patients, but occurred in 6 and 1 of the 11 NF p atients, and in 14 and 3 of the 15 TPN patients, respectively. Fasting gall bladder areas were significantly larger in the TPN group than in the other two groups. The TPN group showed a marked decrease in cerulein-induced gall bladder contractility. Fasting plasma CCK levels were lower in the TPN grou p than in the OI group. Conclusions. Our results indicate that elderly pati ents with CVD confined to bed over long periods are not necessarily at risk of gallbladder sludge or gallstone formation, and the development of these features may be associated with the feeding method. The predisposition of CVD patients on TPN to gallbladder disease is probably caused by failure of gallbladder contraction, resulting from insufficient secretion of CCK and impaired sensitivity of the gallbladder to CCK.