title: The effect of acute oral erythromycin on gallbladder motility and on upper gastrointestinal symptoms in gastrectomized patients with and without gallstones: a randomized, placebo-controlled ultrasonographic study.
abstract: OBJECTIVE
  Gastrectomy might be a risk factor for cholelithiasis and gallbladder stasis might play a major role. We studied fasting and postprandial gallbladder motility with 600 mg oral erythromycin or placebo in gastrectomized patients (with and without gallstones) and controls.
  
  
  METHODS
  Seventeen patients operated on for gastric cancer (subtotal gastrectomy: n = 10, total gastrectomy: n = 7) were compared with 20 sex- and body-size matched healthy controls. Subjects randomly received erythromycin or placebo 30 min before the ingestion of a standard 200 ml liquid test meal. Gallbladder volume was estimated by ultrasonography until 120 min after test meal. A visual analog scale monitored GI perception of appetite, satiety, nausea, abdominal fullness and epigastric pain.
  
  
  RESULTS
  Gastrectomized patients had increased fasting gallbladder volume (35.9 +/- 3.4 ml versus 21.0 +/- 1.4 ml, p = 0.0005) with faster postmeal emptying (T/2 14.8 +/- 1.1 min versus 23.5 +/- 1.5 min, p = 0.00019) than controls. Six patients developed small and asymptomatic gallstones, which did not influence gallbladder motility. In these patients, fasting gallbladder volume increased with time after surgery (r = +0.82, p = 0.047). Perception of satiety, abdominal fullness, and epigastric pain after ingestion of the test meal were all significantly greater in patients than in controls. Erythromycin significantly enhanced gallbladder emptying during fasting (p = 0.001) and postprandially in both patients and controls (0.002 < p < 0.017) and significantly reduced postmeal satiety and epigastric discomfort in gastrectomized patients.
  
  
  CONCLUSIONS
  Increased fasting volume might be a form of stasis, predisposing patients to gallstone formation. Erythromycin improves fasting and postprandial gallbladder emptying and decreases upper GI symptoms in gastrectomized patients.
authors.affiliation: Department of Internal Medicine and Public Medicine, University Medical School, Bari, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Portincasa
authors.forename: D F
authors.initials: DF
authors.lastname: Altomare
authors.forename: A
authors.initials: A
authors.lastname: Moschetta
authors.forename: G
authors.initials: G
authors.lastname: Baldassarre
authors.forename: A
authors.initials: A
authors.lastname: Di Ciaula
authors.forename: N G
authors.initials: NG
authors.lastname: Venneman
authors.forename: M
authors.initials: M
authors.lastname: Rinaldi
authors.forename: G
authors.initials: G
authors.lastname: Vendemiale
authors.forename: V
authors.initials: V
authors.lastname: Memeo
authors.forename: G P
authors.initials: GP
authors.lastname: vanBerge-Henegouwen
authors.forename: G
authors.initials: G
authors.lastname: Palasciano
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001066:Appetite; D002769:Cholelithiasis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004917:Erythromycin / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D005526:Food, Formulated; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000187:drug effects*; D016473:Gallbladder Emptying / Q000187:drug effects*; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012527:Satiation; D012677:Sensation; D013274:Stomach Neoplasms / Q000601:surgery; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin