IMPAIRED GALLBLADDER AND GASTRIC-MOTILITY AND PATHOLOGICAL GASTROESOPHAGEAL REFLUX IN GALLSTONE PATIENTS

Impaired gallbladder motility is common in gallstone patients and migh t be associated with other gastrointestinal defects. Twenty patients w ith small stones in an opacified gallbladder at oral cholecystography and 20 healthy subjects homogeneous for sex, age and body size were st udied by ultrasonography to assess gallbladder and gastric emptying si multaneously in response to a standard liquid meal (120 kcal, 11 g fat , 200 mL). The same subjects underwent ambulatory 24-h gastro-oesophag eal pH monitoring. Dyspeptic symptoms were specifically investigated u sing a questionnaire. Gallstone patients had a significantly larger fa sting (P<0.05) and residual (P<0.005) gallbladder volume with slower ( P<0.05) and less complete (ANOVA, 0.001 < P < 0.05) gastric emptying t han healthy control subjects. The speed of antral emptying was signifi cantly correlated with the speed of gallbladder emptying (n = 40, r = + 0.31, P < 0.05). Pathological gastro-oesophageal reflux was present in 75% and 15% of patients and control subjects respectively (P<0.05). Overall, 95% of gallstone patients had abnormal pH profiles resulting from pathological gastro-oesophageal reflux and/or prolonged gastric alkalinization. The speed of post-prandial antral emptying was signifi cantly correlated with the duration of the longest gastro-oesophageal reflux episode (r = + 0.30, P < 0.03) and duodeno-gastric reflux episo de (r = + 0.80, P < 0.02). Best predictors for gastric alkalinization were the following indices of gallbladder function: large fasting volu me (P = 0.03), large ejection volume (P=0.009) and slower emptying (P = 0.032). Gallbladder and gastric motility were similar in patients wi th (n = 12) and without (n = 8) dyspeptic symptoms. Pathological gastr o-oesophageal reflux was found in 83 % of dyspeptic patients and in 25 % of patients without dyspepsia (P < 0.01). When reflux was present, i t was significantly less in asymptomatic than in dyspeptic patients [t ime at pH<4, median (range): 6.4% (3.2-22.6%) vs. 47.8%(2.1-87%), P<0. 05]. This study shows that a subgroup of gallstone patients with small -mainly asymptomatic-stones have impaired gallbladder and gastric moti lity as well as abnormal gastro-oesophageal pH-profiles. These finding s point to the existence of multiple functional defects of the upper g astrointestinal tract in gallstone disease.