GALLBLADDER MOTILITY AND CHOLECYSTOKININ SECRETION IN CHRONIC-PANCREATITIS - RELATIONSHIP WITH EXOCRINE PANCREATIC FUNCTION

Background/Aims: Postprandial gallbladder motility is regulated mainly by the hormone cholecystokinin (CCK). Since CCK secretion mag be redu ced in patients with pancreatic insufficiency (PI), we studied postpra ndial gallbladder motility in these patients. Methods: Fifteen patient s with PI due to chronic pancreatitis and 17 healthy control subjects were studied. Gallbladder volumes (ultrasonography) and plasma CCK con centrations (RIA) were determined at regular intervals for 120 min aft er meal ingestion. Urinary PAPA and faecal fat excretion were measured to determine pancreatic exocrine function. Results: Patients with PI had larger fasting gallbladder volumes than controls (48+/-6 cm(3) ver sus 29+/-2 cm(3); p<0.01), Gallbladder ejection volume at time 120 min was not significantly different between patients with PI (14+/-4 cm(3 )) and controls (20+/-2 cm(3)). However, the percentage postprandial g allbladder emptying in patients with PI was significantly reduced comp ared to controls (at 120 min: 29+/-8% versus 68+/-3%; p<0.001). Residu al postprandial gallbladder volume was increased in patients with PI c ompared to controls (at 120 min: 34+/-4 cm(3) versus 9+/-1 cm(3); p<0. 001). Postprandial endogenous CCK secretion was significantly reduced in patients with PI compared to controls (78+/-13 pM.120 min versus 15 5+/-14 pM.120 min; p<0.001). Postprandial gallbladder emptying (%) was related to the degree of exocrine pancreatic insufficiency (r=0.81; p <0.001). Conclusions: In patients with pancreatic insufficiency due to chronic pancreatitis: 1) fasting and residual postprandial gallbladde r volumes are significantly increased; 2) postprandial CCK secretion a nd percentage gallbladder contraction are significantly reduced; 3) pe rcentage postprandial gallbladder emptying is related to the degree of pancreatic exocrine insufficiency.