Gallbladder disease is a common condition that typically affects young people or otherwise healthy individuals. Risk factors include obesity, diabetes, female sex, pregnancy, family history, rapid weight loss, liquid protein diet, race or ethnic background. Usually, fatigue gallstones are suspected especially when symptoms such as abdominal pain in the right abdomen, nausea, vomiting, bloating etc. occur within 15 to 90 minutes. Ultrasonography of the gall bladder is the first examination and confirms the presence or absence of gallstones. Surgical removal of the gallbladder is recommended when gallstones are confirmed.
However, if the ultrasound is negative or normal and gallbladder disease is suspected, a nuclear test called biliary scintigraphy or, more generally, HIDA scan is ordered. The basis of this test is the fact that radiolabeled chemicals are administered intravenously, concentrated in the liver, and before bile is stored in the gall bladder during meals. When the gall bladder is diagnosed, it is not seen in the scan due to gallbladder obstruction, and when a hormone called cholecystokinin (CCK) is administered intravenously it will not be empty as expected. CCK is present in the body and is released with meals to stimulate bile drainage of bile into the intestine for digestion. Typically, the gall bladder empties more than one-third of its volume when CCK is given during a HIDA scan, but usually does not exceed 70-80%. The proportion of the volume in which the gall bladder becomes empty is called ejection fraction. Low ejection fraction is typical of affected gall bladder. Representative pain of the gallbladder disease and reproduction of the low ejection fraction are considered as diagnosis of gall bladder disease without gallstones and it is recommended that the gall bladder be surgically removed.
Abnormal phenomena are observed in some celiac disease patients. Gallbladder type abdominal pain without gallstone and "supernatant" gallbladder drainage. Surgery relieves pain of the gallbladder type and finds the affected gallbladder. Radiology studies have been reported in literature revealing this phenomenon despite the fact that the medical world has lost significance.
In celiac disease, various ultrasonic findings are reported mainly in European literature. Colli et. In Italy, attention was paid to the rapid increase in ultrasound gallbladder volume in untreated celiac patients and Mariciani et al. al. In the UK, MRI was used to increase the amount of gall bladder and increase the rate of gall bladder emptying. Low levels of CCK have been reported in celiac patients (Deprez et al. 2002, Rehfeld 2004). The doctor had several celiac patients with high gall bladder emptying rates (typically> 90%) associated with classical gallbladder symptoms resolved after gallbladder surgery. Chronic gallbladder disease was confirmed pathologically.
For celiac patients, it is necessary to consider gallbladder disease regularly by normal ultrasonography and HIDA examination. Especially when the 'normal' ejection fraction is noticed and the pain is reproduced with CCK. Patients with abnormal high gallbladder efflux fractions should be considered Celiacs that may not be diagnosed and should undergo celiac disease blood tests and consider upper endoscopy with small bowel biopsy.
Fraquelli M. Colli A; Corcci A; Bardella MT; Trovato C; Pometta R; Pagliarulo M; Conte D. Accuracy of ultrasound examination in the prediction of celiac disease. Arch intern Med. 2004; 164 (2): 169-74.
2. Marciani L; Coleman NS; Dunlop SP; Singh G; Marsden CA; Holmes GK; Spiller RC; Gowland PA. Gallbladder contraction, gastric emptying and abdominal motility: single visit assessment of upper GI function in untreated celiac disease using echogenic plane MRI. J Magn Reson Imaging. 2005; 22 (5): 634-8.
Sustainable decrease in plasma cholecystokinin levels in celiac patients with gluten-free diet: history of histological studies. Deprez P; Sempoux C; Van Beers BE; Jure A; Robert A; Rahier J; Geubel A; Pauwels S; Mainguet P. Proportional role of natural change and nutrient hydrolysis. Regul Pept. 2002; 110 (1): 55-63
4. Rehfeld JF. Clinical endocrine and metabolism. Cholecystokinin. Best Practice Chris Endocrinol Metab. 2004; 18 (4): 569-86.
