Common pathogenetic mechanisms in symptomatic, uncomplicated gallstone disease and functional dyspepsia: volume measurement of gallbladder and antrum using three-dimensional ultrasonography.

Abstract

Following cholecystectomy for uncomplicated gallstone disease (GS) some patients experience persistent symptoms suggesting an underlying functional disorder. To study this phenomenon, we have compared symptomatic GS with functional dyspepsia (FD) patients and healthy individuals (C) with respect to putative pathogenetic mechanisms. Gallbladder and gastric antrum volumes were estimated with three-dimensional (3D) ultrasonography before and 10 min after ingestion of 500 ml meat soup in 18 patients with GS. Volume estimation was performed digitally after interactive manual tracing and organ reconstruction in three dimensions. Respiratory sinus arrhythmia (RSA) was calculated to index vagal tone. Abdominal symptoms were assessed by interview. The results were compared to previously published data in patients with FD and C investigated with the exact same methods. No significant differences were found between groups with respect to fasting gallbladder or gallbladder emptying. Antral volumes both fasting (P < 0.05) and postprandially (P < 0.01) were larger in GS and FD than in C. The soup meal induced dyspeptic symptoms in 2/18 (11%) of C, 12/18 (67%) of GS and 15/17 (88%) of FD patients (P < 0.001). Compared with C, both GS and FD patients had significantly decreased vagal tone (P < 0.001). There was no significant difference between GS and FD patients with respect to antral volume, vagal tone, or symptoms. We concluded that both gallstone and functional dyspepsia patients are characterized by dyspeptic symptoms in response to ingestion of 500 ml of meat soup, a wide gastric antrum, low vagal tone, but normal gallbladder size and emptying. Thus, patients with symptomatic, uncomplicated gallstone disease and functional dyspepsia seem to have common pathogenetic mechanisms.