The Possible Role of Gallbladder Motor Dysfunction in Patients with Idiopathic Bile Acid Diarrhoea

Purpose: The idiopathic bile acid diarrhoea(BAD) is a rather frequent finding in diarrhoea-predominant irritable bowel syndrome(IBS-D) patients and is responsive to cholestiramine.The purpose is to investigate a possible pathophysiological role of gallbladder motor activity in patients with idiopathic BAD.

Methods: We examined the gallbladder volume before and 15’,30’,45’ and 60’ after a 300 Kcal meal with a D3 sonographic technique in 52 IBS-D patients with postprandial diarrhoea responsive to cholestyramine(group R).The ejection fraction at various times was calculated and compared by means of Student t test with the corresponding values of 32 healthy subjects(group C)and of 14 IBS-D patients not responsive to cholestiramine(group NR).The ejection fraction at various times of each patient of group R was examined whether fell in the 99% confidence interval(CI) of the corresponding means of group C.

Results: The gallbladder ejection fractions of the group R were significantly higher than those of the group C,at 30’,45’ and 60’, and than those of group NR, at 15’, 30’ and 60’.During all time periods nearly 50% of group R patients were above the CI upper limit and about 10% below the lower limit,whereas at 15’ about 44% was above the upper CI limit and at 60’about 17% remained below the CI lower limit.

Conclusions: The study showed that almost half of IBS-D patients responsive to cholestyramine had a“hyperkinetic gallbladder”,that quickly ejects an increased amount of bile in the intestine, and nearly one-fifth had a “hypokinetic gallbladder”,with slow and scarcer than normal emptying,suggesting that a dyskinetic gallbladder could play a role in the pathophysiology of BAD.

Keywords: Bile acid diarrhoea; cholestiramine; gallbladder dysmotility; gallbladder ejection fraction; irritable bowel syndrome.