Effects of bioactive agents on biliary motor function

Abstract

Our understanding of biliary motility under normal and pathophysiologic conditions is still incomplete, but there have been recent advances. Of particular interest are the mechanisms involved in gallbladder filling and emptying, with a focus on understanding the processes underlying impaired gallbladder emptying leading to gallbladder dyskinesia and the formation of gallstones or cholecystitis. The sphincter of Oddi (SO) is a complex neuromuscular structure. Recent studies have attempted to unravel the specific neural or hormonal mechanisms operating under normal physiologic conditions and those that may lead to SO dysfunction. Furthermore, new research fronts are emerging, including the role of leptin in obese patients with impaired biliary motility and the action of electroacupuncture for possible treatment of SO dysfunction. This review illustrates the broad front of current research regarding the effects of bioactive agents on biliary motility, including enteric hormones, nitric oxide, opioids, inflammatory mediators, leptin, protease inhibitors, neurotransmitters, and electroacupuncture.

Gallbladder wall inflammatory cells in pediatric patients with biliary dyskinesia and cholelithiasis: a pilot study

“…Gallbladder mast cells would have the potential to contribute to pain generation by at least 2 mechanisms: sensitivity to distension as seen with mast cell degranulation in the gastrointestinal tract and through the generation of gallbladder spasms induced by mast cell products. For example, both histamine and cysteinyl leukotrienes increase the excitability of gallbladder smooth muscle and lead to contraction [22][23][24][25].…”

The sphincter of Oddi: understanding its control and function

“…There are many neurotransmitters and/or neuromodulators that can influence SO motility 34 . Such agents may be part of the normal physiological regulation of SO function, and others are part of pathological conditions such as inflammation.…”

“…In the SO immunohistochemical studies have identified the presence of a number of neurotransmitters or neuromodulating agents, 34 with recent studies finding NO synthase, substance P and gastrin‐releasing peptide 14,35,36 . However presence of a neurotransmitter does not imply an effect on motility, as determined in the associated functional studies 36 .…”

Exogenous purines induce differential responses in the proximal and distal regions of the possum sphincter of Oddi

“…The SO displays spontaneous activity, which is primarily myogenic in nature, but is subject to regulation via extensive neural pathways and reflexes. SO motor activity is the complex integration of several signalling systems, which include neural inputs and the effects of bioactive agents (Toouli & Baker, 1991; Woods et al. , 2003a; Woods et al.…”