title: Cholecystokinin receptor positivity in children with chronic acalculous gallbladder dysfunction: a pilot study to investigate the etiology of chronic acalculous gallbladder dysfunction.
abstract: BACKGROUND
  The etiology of chronic acalculous gallbladder dysfunction (CAGD) is unknown. However, cholecystectomy is being performed as treatment, based on gallbladder (GB) ejection fraction studies. The aim of this study was to examine the pathology and immunohistology of GBs from children with CAGD.
  
  
  METHODS
  Children with a diagnosis of CAGD were identified. Control patients had their GB removed for nonbiliary indications. Immunoperoxidase staining was performed using rabbit antihuman cholecystokinin receptor (CCK-R) antibody. The pathologist was blinded to the study and controls.
  
  
  RESULTS
  Fifteen children were evaluated: 6 children with CAGD and 9 controls. All children with CAGD had abnormal cholecystokinin-stimulated nuclear imaging. Ejection fractions ranged from 8% to 30%. All patients reported resolution of symptoms on follow-up at 6 months. Histopathology of the GB was normal for both the controls and children with CAGD. Both control and CAGD GBs demonstrated positive staining for CCK-R in the vascular endothelium and smooth muscle. Mucosal epithelial staining was only observed in 5 of 6 of GBs of children with CAGD. In the sixth GB, the epithelium was too necrotic to assess.
  
  
  CONCLUSIONS
  In this pilot study, expression of CCK-Rs in the epithelial cells is noted in children with CAGD compared with controls. The significance of this finding requires further investigation.
authors.affiliation: Department of Pediatric Surgery, University of Michigan Ann Arbor Michigan, MI 48109, USA.
authors.forename: G
authors.initials: G
authors.lastname: Karplus
authors.forename: R
authors.initials: R
authors.lastname: Ruiz
authors.forename: Dafydd G
authors.initials: DG
authors.lastname: Thomas
authors.forename: P F
authors.initials: PF
authors.lastname: Ehrlich
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D017081:Cholecystectomy, Laparoscopic; D002908:Chronic Disease; D003593:Cytoplasm / Q000473:pathology; D004848:Epithelium / Q000473:pathology; D005705:Gallbladder Diseases / Q000378:metabolism* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D009131:Muscle, Smooth, Vascular / Q000473:pathology; D010865:Pilot Projects; D011949:Receptors, Cholecystokinin / Q000032:analysis*
chemical_list: D011949:Receptors, Cholecystokinin