title: Sludge and stone formation in the gallbladder in bedridden elderly patients with cerebrovascular disease: influence of feeding method.
abstract: OBJECTIVE
  The incidence of gallbladder sludge or gallstone formation in bedridden patients with cerebrovascular disease (CVD) remains obscure. The aim of this study was to determine the incidence, relationship to feeding method, and mechanisms of gallbladder sludge and gallstone formation in elderly patients with CVD.
  
  
  METHODS
  Using ultrasonography, we determined the development of gallbladder sludge and gallstone over a 12-month period, the area of the gallbladder, the gallbladder contractile response to cerulein, and fasting levels of plasma cholecystokinin (CCK) in 40 bedridden elderly patients with CVD. The patients were divided into three groups based on the feeding method: oral ingestion (OI), nasogastric feeding (NF), and total parenteral nutrition (TPN).
  
  
  RESULTS
  Gallbladder sludge and gallstone were not observed in any of the 14 OI patients, but occurred in 6 and 1 of the 11 NF patients, and in 14 and 3 of the 15 TPN patients, respectively. Fasting gallbladder areas were significantly larger in the TPN group than in the other two groups. The TPN group showed a marked decrease in cerulein-induced gallbladder contractility. Fasting plasma CCK levels were lower in the TPN group than in the OI group.
  
  
  CONCLUSIONS
  Our results indicate that elderly patients with CVD confined to bed over long periods are not necessarily at risk of gallbladder sludge or gallstone formation, and the development of these features may be associated with the feeding method. The predisposition of CVD patients on TPN to gallbladder disease is probably caused by failure of gallbladder contraction, resulting from insufficient secretion of CCK and impaired sensitivity of the gallbladder to CCK.
authors.affiliation: Second Department of Internal Medicine, Nagasaki University School of Medicine, Sakamoto, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Onizuka
authors.forename: Y
authors.initials: Y
authors.lastname: Mizuta
authors.forename: H
authors.initials: H
authors.lastname: Isomoto
authors.forename: F
authors.initials: F
authors.lastname: Takeshima
authors.forename: K
authors.initials: K
authors.lastname: Murase
authors.forename: M
authors.initials: M
authors.lastname: Miyazaki
authors.forename: H
authors.initials: H
authors.lastname: Ogata
authors.forename: K
authors.initials: K
authors.lastname: Otsuka
authors.forename: I
authors.initials: I
authors.lastname: Murata
authors.forename: S
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002108:Ceruletide; D002766:Cholecystokinin / Q000097:blood; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000209:etiology*; D004435:Eating; D005248:Feeding Methods / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000502:physiology; D006801:Humans; D007441:Intubation, Gastrointestinal; D007564:Japan; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D020521:Stroke / Q000150:complications*; D014463:Ultrasonography
chemical_list: D002108:Ceruletide; D002766:Cholecystokinin