Gallbaldder contractility and sphincter of oddi Motility in patients with cholecystolithiasis and their contribution to associated symptoms

الملخص EN

The aim of this work was to study the state of gall bladder contractility and sphincter of Odd motility in patients with gallbladder stones and their relation to the severity of associated pain.

A cohort of 40 patients selected for elective cholecystectomy for gallstone disease was prospectively studied.

Pain was assessed using a visual analogue scale, gallbladder contractility using fatty meal and, ultrasonography measurements sphincter of Odd motility using a water perfused monomeric catheter.

Poor gallbladder contraction was found in 72.5% of patients.

High sphincter of Odd basal pressure was found in 18.2% of studied patients.

Significantly higher visual analogue scales were found in patients with good gallbladder contractility and patients with high sphincter of Odd basal pressure.

Biliary stasis is common in patients with cholecystolithiasis.

Severity of biliary pain depends on the ability of the gallbladder to contract and high pressure in the sphincter of Odd. Does not necessary relieve all patients from their associated symptoms especially pain.

(8) Many theories have been put forward to explain the mechanism of pain in biliary disease.

Gallbladder dysmotility which promotes cholesterol crystal entrapment in the mucus layer of the gallbladder causes chronic inflammation leading to abnormal stretching of the gallbladder wall and pain.

(9) A narrow cystic duct may also cause pain in a manner similar to stone impaction.

(10) Others, have hypothesized that pain could result from gallbladder distension as a result of incoordination between gallbladder contraction and sphincter of Odd relaxation.

(11) Finally, visceral hyperalgesia (severe pain evoked by mildly painful stimuli) is thought to be responsible for pain in many patients with biliary disease.

(12, 13) As the mechanisms of biliary pain in patients with gallstones are still not clear; this study has been initiated with the aim to evaluate the role of gall bladder contractility and sphincter of Odd motility to the associated pain in patients with chole-cystolithiasis.