Altered antroduodenal motility after cholecystectomy

Perdikis, Galen; Wilson, Paul; Hinder, Ronald A.; Redmond, Elizabeth; Wetscher, Gerold J.; Neary, Patricia; Adrian, Thomas E.; Quigley, Eamonn Martin

doi:10.1016/s0002-9610(05)80131-x

Cited by 60 publications

(32 citation statements)

References 14 publications

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“…As this prolonged phase-I duration could not be explained by a difference in the preceding phase-III origin [35], another unknown mechanism must be involved. A prolonged phase-I duration has also been observed in gallstone patients after a cholecystectomy, probably as a consequence of an enlarged proximal duodenal bile acid pool [24]. Whether the prolonged phase I in our study after bile infusion is also associated with an enlarged bile acid pool in the proximal duodenum due to the infusion is unknown.…”

Section: Discussionmentioning

confidence: 51%

“…In addition, changes in gastroduodenal motility have been demonstrated in cholecystectomy patients compared with normal subjects. In these patients the duration of phase III in the proximal duodenum is decreased, propagation of phase III slowed, duration of phase I prolonged and oro-caecal transit time prolonged [24, 25]. Therefore, the role of bile per se, with exclusion of pancreatic secretion products, in the regulation of inter-digestive gastrointestinal and gallbladder motility and in the release of motilin needs further study.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Intraduodenal Bile on Interdigestive Gastrointestinal and Gallbladder Motility in Healthy Subjects

Luiking¹,

Kloppers²,

Roelofs³

et al. 2001

Digestion

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Background/Aims: The enterohepatic circulation of bile acids is related to normal inter-digestive gastrointestinal motility, with the gut peptide motilin also being involved. This study aimed to investigate the effect of intraduodenal artificial bile infusion on antroduodenal and gallbladder motility so as to further elucidate the controlling factors. Methods: Twelve fasting, healthy male volunteers received artificial bile (80 mol% bile acids; 15 mol% phospholipids; 5 mol% cholesterol) or placebo (saline) intraduodenally for 10 min starting 30 min after the end of phase III, according to a double-blind, randomised, cross-over design. Antroduodenal motility, gallbladder volumes, and plasma motilin levels were measured. All values are means ± SEM. Results: The interval between infusion and the subsequent phase III, as well as the origin of this phase III were not significantly different between bile and saline. Antral pressure waves were significantly more frequent during and immediately after bile infusion compared with saline infusion (p < 0.05). The duration of phase I following infusion was significantly longer after bile (24.8 ± 3.7 min) than after saline infusion (13.1 ± 1.7 min; p < 0.05). The mean gallbladder volume tended to increase in the hours following bile infusion, but to decrease after saline infusion (p = 0.06). Plasma motilin increased after bile and saline infusion in an almost identical way. Conclusion: This study provides no clear evidence for a role of intraduodenal artificial bile (i.e. its main constituents) in the regulation of migrating motor complex cycling or feedback inhibition of inter-digestive gallbladder emptying.

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Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Effects of Intraduodenal Bile on Interdigestive Gastrointestinal and Gallbladder Motility in Healthy Subjects

Luiking¹,

Kloppers²,

Roelofs³

et al. 2001

Digestion

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“…Moreover, it was thought that reflux symptoms in these patients worsen with increased biliary symptoms after cholecystectomy due to a high-fat diet intake and weight gain. Alterations in the motility of the upper gastrointestinal tract and delayed stomach emptying caused by duodenal adhesions may also contribute to GERD (25). There was no significant increase in reflux after cholecystectomy in the limited number of studies based on these data.…”

Section: Cholecystectomymentioning

confidence: 83%

Which diseases are risk factors for developing gastroesophageal reflux disease?

Akyüz

Soyer²

2017

Turk J Gastroenterol

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Gastroesophageal reflux disease (GERD) is known to present with various extraesophageal symptoms and complications. In contrast, several diseases affecting the motility of the esophagus and some approaches that alter the upper gastrointestinal tract anatomy may result in GERD. Certain diseases and conditions often mentioned with GERD will be briefly discussed in this section. Systemic SclerosisEsophageal motility is impaired in 70-90% of patients with systemic sclerosis (1-3). On histological examination, smooth muscle atrophy and fibrosis causing motor activity abnormalities in two-thirds of the distal esophagus are often determined (4). Motility studies have shown that the amplitude of peristaltic contractions decreases or that there is no peristaltic contraction in this region (5-7). Abnormal peristalsis and decreased lower esophageal sphincter (LES) pressure reduce acid clearance and prolong the contact of acid with the mucosa (8). As a result, GERD develops in patients with scleroderma. In many cross-sectional studies using different methodologies, the prevalence of GERD has been reported to be at rates of up to 70% (9-15). Diabetes MellitusFurthermore, various factors showing tendency to GERD were identified in diabetes mellitus. Among these,• Reduced salivary secretion associated with diabetic neuropathy, • Delayed gastric emptying, • Decreased acid clearance due to reduced motor activity of the esophagus/stomach related motor/autonomic neuropathy, • Increased sensory thresholds associated with sensory nerve damage of the esophagus, • Acid regurgitation caused by the increased frequency of transient LES relaxations related to neuropathy, CholecystectomyThe reservoir function of the gallbladder disappears after cholecystectomy, and bile flow becomes continuous (20,21). Qualitative changes may appear at the levels of gastrointestinal hormones (22,23). Consequently, alterations in the qualitative bile content and more frequent transient LES relaxation may occur (24). Moreover, it was thought that reflux symptoms in these patients worsen with increased biliary symptoms after cholecystectomy due to a high-fat diet intake and weight gain. Alterations in the motility of the upper gastrointestinal tract and delayed stomach emptying caused by duodenal adhesions may also contribute to GERD (25). There was no significant increase in reflux after cholecystectomy in the limited number of studies based on these data. Uyanıkoğlu et al. (26) used the impedance method and reported increased reflux after surgery and that the pH was <4% higher than that before surgery; however, it was similar to the control group. In another study, Lin et al. (27) compared patients with hernia surgery and cholecystectomy. Reduction in the reflux symptom score was 35% in patients, while it was 39% in controls (p=0.11). Sleeve GastrectomyMechanisms that may induce increased GERD in patients with GERD with sleeve gastrectomy include hypotensive LES (28), blunting of the angle of His (29), decreased gastric compliance (30), delayed gastric em...

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“…In humans, decreased antral motility has been reported to be associated with such pathological conditions as duodenogastric reflux [17,18], gastroesophageal reflux [19], microbial overgrowth [20], and impaired gastric emptying [21]. Abnormal reflux of duodenal contents (bile reflux) into the stomach, which is known to occur in critically ill patients [22,23,24] may favor the occurrence of gastric and/or esophageal erosions [25].…”

Section: Discussionmentioning

confidence: 99%