Review article: gall-bladder motor function in diabetes mellitus.
Although some controversy exists, diabetic patients generally are thought to have a two- to threefold increased risk of cholesterol gallstones. From previous studies there is no convincing evidence for a supersaturated bile in diabetics, whereas several reports indicate that impaired gall-bladder emptying could be one of the important factors in the increased incidence of gallstones in diabetics. However, studies of gall-bladder motility in diabetics have yielded conflicting results, probably because of substantial heterogeneity in the patients studied, emptying stimulus and technique used to assess gall-bladder motor function. The mechanism of the gall-bladder emptying abnormality in diabetics is not completely understood, although it has been proposed that it could represent a manifestation of denervation caused by visceral neuropathy. Based on normal post-prandial cholecystokinin release, it can be ruled out that impaired cholecystokinin release is the mechanism responsible for reduced gall-bladder emptying in diabetics. Other possible explanations for impaired gall-bladder contraction in diabetics include a decreased sensitivity of the smooth muscle of the gall-bladder to plasma cholecystokinin, and/or decreased cholecystokinin receptors on the gall-bladder wall.
Pazzi
P
P
Department of Gastroenterology, S. Anna Hospital, Ferrara, Italy. pzp@unife.it
Scagliarini
R
R
Gamberini
S
S
Pezzoli
A
A
D002766:Cholecystokinin / Q000378:metabolism / Q000502:physiology; D002769:Cholelithiasis / Q000209:etiology / Q000503:physiopathology*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005704:Gallbladder / Q000502:physiology*; D005769:Gastrointestinal Motility; D006801:Humans; D009130:Muscle, Smooth / Q000502:physiology; D019518:Postprandial Period; D011949:Receptors, Cholecystokinin / Q000502:physiology
D011949:Receptors, Cholecystokinin; D002766:Cholecystokinin