Original Contribution

American Journal of Gastroenterology (1999) 94, 1866–1870; doi:10.1111/j.1572-0241.1999.01221.x

Gallbladder emptying and somatostatin and cholecystokinin plasma levels in celiac disease

Mirella Fraquelli MD1, Maria Teresa Bardella MD1, Maddalena Peracchi MD1, Bruno Mario Cesana MD2, Paolo A Bianchi MD1 and Dario Conte MD1

  1. 1Cattedra di Gastroenterologia, Istituto di Scienze Mediche, and Milan, Italy
  2. 2Epidemiology Unit, IRCCS Ospedale Maggiore, Milan, Italy

Correspondence: Dario Conte, MD, Cattedra di Gastroenterologia, Granelli 3° piano, IRCCS—Ospedale Maggiore, Via F. Sforza 35, 20122 Milano, Italy

Received 11 September 1998; Revised  0000; Accepted 18 January 1999.

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Abstract

OBJECTIVES:

 

Gallbladder hypomotility in celiac disease has been attributed to decreased cholecystokinin secretion. The possible influence of somatostatin, which inhibits gallbladder motility, however, has never been evaluated. In this study gallbladder emptying and cholecystokinin and somatostatin plasma levels were evaluated in response to a fatty meal in patients with celiac disease at diagnosis and after long-term gluten-free diet and in controls.

METHODS:

 

Gallbladder volume and plasma levels of cholecystokinin and somatostatin were measured by ultrasonography and radioimmunoassay, respectively, at 0 time and 30, 60, 75, and 90 min after an oral fatty meal (227 kcal, 45% fat) in 10 celiac patients at diagnosis and after 18 months of successful gluten-free diet and in 10 healthy subjects. The pattern of gallbladder emptying was evaluated by mixed factorial analysis of variance and the curve fitting by multiple regression analysis.

RESULTS:

 

Patients at diagnosis had significantly greater fasting gallbladder volume and higher somatostatin plasma levels than controls (25.7 plusminus SD 9.7 ml vs 16.8 plusminus 7.0 ml, p= 0.021 and 9.3 plusminus 4.6 vs 4.8 plusminus 3.4 pmol/L, p= 0.023, respectively), significantly lower fatty meal-induced gallbladder ejection fraction (55 plusminus 11.2%vs 76 plusminus 7.2%, p= 0.005), and cholecystokinin peak and smaller area under the cholecystokinin secretion curve (3.1 plusminus 2.3 pmol/L vs 10.5 plusminus 6.9 pmol/L, p= 0.028 and 157 plusminus 142 pmol/L/90 min vs 453 plusminus 229 pmol/L/90 min, p= 0.028, respectively). The two groups had a similar emptying pattern (p= 0.8913) expressed by a significant quadratic term of the emptying function (p= 0.0001). The mean overall emptying volume was significantly greater in patients than in controls (p= 0.0007). Gluten-free diet normalized these findings.

CONCLUSIONS:

 

In patients at diagnosis, elevated somatostatin levels were associated with increased gallbladder fasting volume, whereas decreased cholecystokinin secretion was responsible for the reduced gallbladder emptying. Gluten-free diet reversed these abnormalities.