title: Mast cell activation and clinical outcome in pediatric cholelithiasis and biliary dyskinesia.
abstract: BACKGROUND
  The current study was undertaken to determine the degree of activation of gallbladder mucosal mast cells, whether mast cell (MC) density or activation differ between patients with and without a positive clinical response to cholecystectomy, and whether either density or activation correlate with gallbladder emptying.
  
  
  RESULTS
  Fifteen biliary dyskinesia (BD) and 13 symptomatic cholelithiasis (CL) patients undergoing cholecystectomy were prospectively enrolled. Gallbladder wall MC density (by immunohistochemistry) and activation (by electron microscopy) were determined. Clinical response was evaluated 30 days post-cholecystectomy on a 5-point Likert-type scale. A complete or nearly complete clinical response was seen in 100% of CL and in 87% of BD patients. The overall degranulation indices were 49.4 ± 18.7% for CL patients and 44.2 ± 16.8% for BD patients. Neither MC density nor activation correlated with the gallbladder ejection fraction. A complete clinical response was associated with lower epithelial MC density.
  
  
  CONCLUSIONS
  Cholecystectomy is efficacious in relieving pain in both CL and BD patients. BD and CL are associated not only with increased MC density but a moderate to high degree of MC activation. A possible relationship between MC density and outcome for BD warrants further investigation.
authors: Department of Pediatrics, The Children's Mercy Hospital, 2401 Gillham Rd,, Kansas City, Missouri, USA. cfriesen@cmh.edu.
authors: Craig A
authors: CA
authors: Friesen
authors: Nancy
authors: N
authors: Neilan
authors: James F
authors: JF
authors: Daniel
authors: Kim
authors: K
authors: Radford
authors: Jennifer V
authors: JV
authors: Schurman
authors: Ding-You
authors: DY
authors: Li
authors: Linda
authors: L
authors: Andre
authors: Shawn D
authors: SD
authors: St Peter
authors: George W
authors: GW
authors: Holcomb