Ingestion of corrosive substances can lead to strictures of the esophagus and stomach. Cicatrization of the lower part of the esophagus can entrap vagal fibers in the process of fibrosis. The aim of the present study was to evaluate gallbladder dysfunction as a sequel to vagal damage in patients with corrosive-induced esophageal strictures. The cephalic phase of gallbladder emptying was stimulated by modified sham feeding according to the chew-and-spit method. Gallbladder volume was measured by ultrasonography using the ellipsoid method after an overnight fast and every 15 min for a period of 90 min after sham feeding in 22 patients and 10 controls. Mean fasting gallbladder volume was significantly greater in patients than in controls (22.09± 9.78 vs. 14.61± 4.42 ml; P = 0.025). After sham feeding the gallbladder ejection fraction was significantly lower in patients than in controls (32.86± 17.21 vs. 49.40± 7.86%; P = 0.007). Patients with cicatrization in the distal one-third of the esophagus had a greater basal gallbladder volume (24.57± 9.2 ml) and significantly lower ejection fraction (20.47± 8.9%) than patients with strictures at other sites (gallbladder volume, 18.50± 10.69 ml; ejection fraction, 47.48± 13.3%; P = 0.001). In conclusion, patients with corrosive-induced esophageal strictures, especially those in the distal one-third, had an increased fasting gallbladder volume and decreased cephalic phase of gallbladder emptying, pointing to impaired vagal cholinergic transmission, possibly due to vagal entrapment in the cicatrization process.
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References
Zargar SA, Kochhar R, Nagi B, et al. : Ingestion of corrosive acids, spectrum of injury to the upper GI tract and natural history. Gastroenterology 97:702–707, 1989
Zargar SA, Kochhar R, Nagi B, et al. : Ingestion of strong corrosive alkalis, spectrum of injury to upper GI tract and natural history. Am J Gastroenterol 87:337–340, 1992
Goldman LP, Weigert JM: Corrosive substance ingestion. A review. Am J Gastroenterol 79:85–90, 1984
Dilawari JB, Singh S, Rao PN, et al. : Corrosive ingestion in man—A clinical endoscopic study. Gut 25:183–187, 1984
Zargar SA, Kochhar R, Mehta S, et al. : Role of fibre optic endoscopy in the management of burns. Gastrointest Endoc 37:165–169, 1991
Ryan JP: Motility of the gallbladder and biliary tree. In Physiology of the Gastrointestinal Tract. Johnson LP, Christensen J, Grossman MI, et al (eds.). New York, 1986, p∼473
Tierney S, Pitt HA, Lillemoe KD: Physiology and pathophysiology of the gallbladder motility. Surg Clin N Am 73:1267–1290, 1993
Luiking YC, Peeters TL, Stolk MFJ: Motilin induces gallbladder emptying and antral contraction in the fasted state in humans. Gut 42:830–835, 1998
Svenberg T, Christofides ND, Fitzpatrick ML, et al. : Interdigestive biliary output in man: relationship to fluctuations in plasma motilin and effect of atropine. Gut 23:1024–1229, 1982
Dodds WJ, Groh WJ, Darweesh RMA: Sonographic measurement of gallbladder volume. Am J Radiology 145:1009–1011, 1985
Masclee AA, Gielkens HA, Lieverse RJ: Gallbladder motility in response to sham feeding and cholecystokinin in lean and obese subjects. Digestion 58(1):43–49, 1997
Masclee AAM, Jansen JBMJ, Driessen WMM, et al. : Effect of truncal vagotomy on cholecystokinin release, gallbladder contraction and gallbladder sensitivity to cholecystokinin in humans. Gastroenterology 98:1338–1341, 1990
Wim PM Hopman, Jan BMJ Janson, Rosenbusch G: Cephalic stimulation of gallbladder contractions in humans: role of cholecystokinin and the cholinergic system. Digestion 38:197–203, 1987
Fisher R, Elizabeth R, Leon SM: Gallbladder emptying response to sham feeding in humans. Gastroenterology 90:1854–1857, 1986
Patankar R, Ozmen MM, Sanderson A: Effect of cisapride on gallbladder emptying and plasma CCK in normal and vagotomized human subjects. Dig Dis Sci 41:543–548, 1996
Robert SF, Elizabeth R, Leon SM: Cholinergic effects on gallbladder emptying in humans. Gastroenterology 89:716–722, 1985
Masclee AAM, Ledeboer ML, Giekens HG: Effect of erythromycin on gallbladder emptying in patients with antrectomy or truncal vagotomy. Am J Gastroenterology 90:973–977, 1995
Clave RA, Gaspar MA: Incidence of gallbladder disease after vagotomy. Am J Surg 118:169–173, 1969
Ihasz M, Griffith CA: Gallstone after vagotomy. Am J Surg 141:48–51, 1981
Friedmann GD, Kannel WB, Dawber TR: The epidemiology of gallbladder disease: observations of the Framingham study. J Chron Dis 19:273–281, 1966
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Khan, B.A., Kochhar, R., Nagi, B. et al. Gall Bladder Emptying in Patients with Corrosive-Induced Esophageal Strictures. Dig Dis Sci 50, 111–115 (2005). https://doi.org/10.1007/s10620-005-1287-8
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DOI: https://doi.org/10.1007/s10620-005-1287-8