Document Detail

Sludge and stone formation in the gallbladder in bedridden elderly patients with cerebrovascular disease: influence of feeding method.
MedLine Citation:
PMID:  11388396     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The incidence of gallbladder sludge or gallstone formation in bedridden patients with cerebrovascular disease (CVD) remains obscure. The aim of this study was to determine the incidence, relationship to feeding method, and mechanisms of gallbladder sludge and gallstone formation in elderly patients with CVD. METHODS: Using ultrasonography, we determined the development of gallbladder sludge and gallstone over a 12-month period, the area of the gallbladder, the gallbladder contractile response to cerulein, and fasting levels of plasma cholecystokinin (CCK) in 40 bedridden elderly patients with CVD. The patients were divided into three groups based on the feeding method: oral ingestion (OI), nasogastric feeding (NF), and total parenteral nutrition (TPN). RESULTS: Gallbladder sludge and gallstone were not observed in any of the 14 OI patients, but occurred in 6 and 1 of the 11 NF patients, and in 14 and 3 of the 15 TPN patients, respectively. Fasting gallbladder areas were significantly larger in the TPN group than in the other two groups. The TPN group showed a marked decrease in cerulein-induced gallbladder contractility. Fasting plasma CCK levels were lower in the TPN group than in the OI group. CONCLUSIONS: Our results indicate that elderly patients with CVD confined to bed over long periods are not necessarily at risk of gallbladder sludge or gallstone formation, and the development of these features may be associated with the feeding method. The predisposition of CVD patients on TPN to gallbladder disease is probably caused by failure of gallbladder contraction, resulting from insufficient secretion of CCK and impaired sensitivity of the gallbladder to CCK.
Y Onizuka; Y Mizuta; H Isomoto; F Takeshima; K Murase; M Miyazaki; H Ogata; K Otsuka; I Murata; S Kohno
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of gastroenterology     Volume:  36     ISSN:  0944-1174     ISO Abbreviation:  J. Gastroenterol.     Publication Date:  2001 May 
Date Detail:
Created Date:  2001-06-04     Completed Date:  2001-10-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9430794     Medline TA:  J Gastroenterol     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  330-7     Citation Subset:  IM    
Second Department of Internal Medicine, Nagasaki University School of Medicine, Sakamoto, Japan.
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MeSH Terms
Aged, 80 and over
Caerulein / diagnostic use
Cholecystokinin / blood
Cholelithiasis / etiology*,  ultrasonography
Feeding Methods / adverse effects*
Follow-Up Studies
Gallbladder / physiology,  ultrasonography
Intubation, Gastrointestinal
Liver Function Tests / methods
Middle Aged
Parenteral Nutrition, Total
Stroke / complications*
Reg. No./Substance:
17650-98-5/Caerulein; 9011-97-6/Cholecystokinin
Comment In:
J Gastroenterol. 2001 May;36(5):356-7   [PMID:  11388402 ]

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