Abstract

BackgroundTegaserod is effective in treating IBS patients with constipation, and does not alter gallbladder motility in healthy individuals or in patients with IBS. However, it is not known if tegaserod affects the biliary tract in gallstone disease, so to this end the effects of tegaserod on bile composition and hepatic secretion of Richardson ground squirrels maintained on an enriched cholesterol diet were examined.ResultsAnimals were fed either a control (0.03%) or enriched (1%) cholesterol diet for 28 days, and treated s.c. with tegaserod (0.1 mg/kg BID) or vehicle. Bile flow, bile acid, phospholipids and cholesterol secretion were measured with standard methods. Tegaserod treatment or enriched cholesterol diet, alone or combination, did not alter body or liver weights. The enriched cholesterol diet increased cholesterol saturation index (CSI), cholesterol concentrations in gallbladder and hepatic duct bile by ~50% and decreased bile acids in gallbladder bile by 17%. Tegaserod treatment reversed these cholesterol-induced changes. None of the treatments, drug or diet, altered fasting gallbladder volume, bile flow and bile salts or phospholipid secretion in normal diet and cholesterol-fed animals. However, tegaserod treatment prevented the decreases in bile acid pool size and cycling frequency caused by the enriched cholesterol diet, consequent to re-establishing normal bile acid to concentrations in the gall bladder. Tegaserod had no effect on these parameters with normal diet animals.ConclusionTegaserod treatment results in increased enterohepatic cycling and lowers cholesterol saturation in the bile of cholesterol-fed animals. These effects would decrease conditions favorable to cholesterol gallstone formation.

Highlights

  • Tegaserod is effective in treating Irritable bowel syndrome (IBS) patients with constipation, and does not alter gallbladder motility in healthy individuals or in patients with IBS

  • Functional 5-HT4 receptors have not been demonstrated in the gallbladder or biliary tract, cisapride, a 5HT4-agonist/5-HT3-antagonist, has been variably reported to increase, decrease, and have no effect on gallbladder volume in human subjects[13,14,15]

  • Our previous work[16] with cisapride, in the Richardson ground squirrel model of cholesterol gallstone formation, revealed that this prokinetic agent reversed the defect in gallbladder contractility, enhanced bile salt secretion and so lowered cholesterol saturation

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Summary

Introduction

Tegaserod is effective in treating IBS patients with constipation, and does not alter gallbladder motility in healthy individuals or in patients with IBS. It is not known if tegaserod affects the biliary tract in gallstone disease, so to this end the effects of tegaserod on bile composition and hepatic secretion of Richardson ground squirrels maintained on an enriched cholesterol diet were examined. A small percentage of patients with IBS may have gallbladder disease[2], and some studies have shown normal[3,4], others enhanced[5], or impaired [6]gallbladder emptying in IBS Despite these contradictions there is a higher rate of cholecystectomy in patients with IBS than that predicted in the general population[5,7]

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