Review article: gall‐bladder motor function in obesity

Abstract

Summary A number of epidemiological studies has established obesity as a risk factor for gallstone disease. More recently, studies have suggested a relationship between gallstone disease and the metabolic syndrome linked to central adiposity, whose cardinal feature is represented by hyperinsulinaemia. Studies on fasting gall‐bladder volume in obese subjects show that this parameter correlates with weight, body mass index (BMI) and body surface area; however, this is also true for large‐sized non‐obese subjects. Gall‐bladder volume also correlates with abdominal fat and with impaired glucose tolerance. In contrast to the well‐established role of bile supersaturation in the pathogenesis of gallstones in obesity, data are controversial on whether gall‐bladder motor function is defective in obese subjects. However, studies were heterogeneous for subjects' BMI, emptying stimulus, technique used and parameters assessed to evaluate gall‐bladder motor function. Also, differences in baseline gall‐bladder volume may lead to wide differences in bile ‘washout' effect despite apparently similar percentage changes in volume or content. Although post‐prandial plasma levels of cholecysto‐ kinin (CCK) are normal in obese subjects, there is some evidence that a sub‐group of obese subjects could have decreased sensitivity to CCK, possibly mediated by hyperinsulinaemia. Further studies using standard physiological stimuli and controlling for glucose tolerance, fasting insulin levels and baseline gall‐bladder volume are needed to establish the role of gall‐bladder motor function in the pathogenesis of gallstone disease in obesity.

Sonographic evaluation of gallbladder volume and ejection fraction in obese women without gallstones

“…Epidemiologic studies have established obesity as a risk factor for development of gallstones. [1][2][3][4] A key factor in the pathogenesis of gallstones is hypomotility of the gallbladder, in which incomplete and infrequent emptying of the contents results in bile stasis and crystal formation. 5 However, data are conflicting concerning whether gallbladder motor function is defective in obese individuals.…”

Acute Cholecystitis after Screening Colonoscopy

“…The mechanism was postulated as an abnormal fatty deposition in the gallbladder mucosa associated with chronic inflammation and tissue damage, which could result in deterioration of gallbladder function [3,4,7]. Other multiple pathogenic links that have been reported are insulin resistance, hyperglycemia, leptin hormonal dysfunction, autonomic neuropathy, and oxidative stress [10][11][12]. However, clinical data which estimated the relationship between steatocholecystitis and contractility of gallbladder is lacking.…”

“…This is induced by abnormal wall structure and decreased response of gallbladder to the neurotransmitter associated with oxidative stress and insulin resistance [10][11][12]. However, clinical estimation data about the relationship between steatocholecystitis and contractility of gallbladder is still lacking.…”

Rol' abdominal'nogo ozhireniya v razvitii motornoy disfunktsii zhelchnogo puzyrya pri kholesterinovom kholelitiaze

“…Но вым сти му лом для по ис ка па -то ге не ти че с кой мо де ли хо ле с те ри но во го хо ле ли ти а за по слу жи ло вы ска зан ное пред по ло же ние о на ли чии не по сред ст вен ной вза и мо свя зи ме та бо ли че с ко го ин -су ли но ре зи с тент но го син д ро ма при ожи ре нии с раз -ви ти ем желч ной дис функ ции. В еди нич ных ра бо тах, ве ду щих ся в этом на прав ле нии, про сле жи ва лась оп ре -де лен ная за ви си мость меж ду объ е ма ми ЖП, ИМТ, вы ра жен но с тью аб до ми наль но го ожи ре ния и сни же -ни ем то ле рант но с ти к глю ко зе [9,12]. В этих же ра бо -тах име лись дан ные о нор маль ном уров не цир ку ли ру -ю ще го ба заль но го и пост пран ди аль но го хо ле ци с то ки -ни на (ХЦК) у лиц с ожи ре ни ем и пу зыр ной ги по то ни -ей.…”

“…В ча ст но с ти ста вят ся под со -мне ние при ня тые ра нее взгля ды о важ ной ро ли пу -зыр ной ги по ки не зии в про цес се кам не об ра зо ва ния у туч ных боль ных и пред ла га ет ся во об ще ис клю чить ее из фак то ров ри с ка ЖКБ при ожи ре нии [5,6,11]. В про -ти во по лож ность этим за яв ле ни ям, про дол жа ет ся изу -че ние слож ной ре гу ля ции мо то ри ки желч но го пу зы ря (ЖП) и ме ха низ мов ее на ру ше ний у лиц, стра да ю щих из бы точ ным ве сом [9,12]. Цель на ше го ис сле до ва ния со сто я ла в вы яв ле нии осо -бен но с тей мо тор ной функ ции желч но го пу зы ря у жен щин, стра дав ших раз лич ны ми ва ри ан та ми ожи ре -ния и желч но ка мен ной бо лез нью.…”