Cisapride improves gallbladder emptying and bile lipid composition in patients with gallstones.
OBJECTIVE
Biliary cholesterol supersaturation, gallbladder stasis and delayed intestinal transit are the key events in cholesterol gallstone formation. We studied the effect of cisapride, a prokinetic drug, on gallbladder emptying and bile composition in patients with gallstone disease undergoing cholecystectomy.


METHODS
Gallbladder emptying, cholesterol saturation index (CSI) and nucleation time were studied in 21 patients with gallstone disease. Eleven patients (cisapride group, age 41.9 +/- 2.9 years) received tablet cisapride 10 mg t.i.d. for 2 weeks, while 10 patients (placebo group, age 42.1 +/- 1.9 years) received placebo for the same duration. Gallbladder emptying was repeated in all patients after a 2-week treatment with cisapride or placebo. Gallbladder bile was obtained at the time of surgery for the measurement of CSI and nucleation time.


RESULTS
Residual volume of the gallbladder decreased (mean +/- SE, 18.6 +/- 2.5 mL vs 10.0 +/- 1.1 mL, P = 0.007), and the ejection fraction increased (43.5 +/- 5.3% vs 60.0 +/- 3.2%, P = 0.007) in patients in the cisapride group, while no change was observed in placebo group patients. Nucleation time was higher in the cisapride group than in the placebo group (14.9 +/- 1.3 days vs 8.0 +/- 0.9 days, P = 0.003). Patients in the cisapride group had a significantly lower cholesterol concentration (molar percentage, 5.1 +/- 0.3% vs 6.8 +/- 0.8%, P = 0.049) and CSI (1.0 +/- 0.1 vs 1.36 +/- 0.11, P = 0.034) than patients in the placebo group.


CONCLUSIONS
Cisapride improves gallbladder emptying and bile lithogenicity in patients with gallstone disease.
Dhiman
R K
RK
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. rkpsdhiman@hotmail.com
Reddi
R
R
Sharma
A
A
Singh
R
R
Kohli
K K
KK
Gupta
S
S
Suri
S
S
Chawla
Y
Y
D000328:Adult; D001646:Bile / Q000737:chemistry*; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D020117:Cisapride / Q000494:pharmacology*; D005260:Female; D016473:Gallbladder Emptying / Q000187:drug effects*; D005765:Gastrointestinal Agents / Q000494:pharmacology*; D006801:Humans; D008055:Lipids / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography
D005765:Gastrointestinal Agents; D008055:Lipids; D020117:Cisapride