Clinical Research
Copyright ©The Author(s) 2004. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 15, 2004; 10(16): 2383-2390
Published online Aug 15, 2004. doi: 10.3748/wjg.v10.i16.2383
Impaired gallbladder motility and delayed orocecal transit contribute to pigment gallstone and biliary sludge formation in β -thalassemia major adults
Piero Portincasa, Antonio Moschetta, Massimo Berardino, Agostino Di Ciaula, Michele Vacca, Giuseppe Baldassarre, Anna Pietrapertosa, Rosario Cammarota, Nunzia Tannoia, Giuseppe Palasciano
Piero Portincasa, Antonio Moschetta, Massimo Berardino, Michele Vacca, Giuseppe Palasciano, Section of Internal Medicine, Department of Internal Medicine and Public Medicine (DIMIMP), University Medical School, Bari, Italy
Agostino Di Ciaula, Division of Internal Medicine, Hospital of Bisceglie, Italy
Giuseppe Baldassarre, Division of Geriatrics, Hospital “Miulli”, Acquaviva delle Fonti, Bari, Italy
Anna Pietrapertosa, Rosario Cammarota, Nunzia Tannoia, Chair of Hematology II, University of Bari, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Professor Piero Portincasa, Section of Internal Medicine, Department of Internal and Public Medicine (DIMIMP), University Medical School of Bari, P.zza G. Cesare 11, 70124 Bari, Italy. p.portincasa@semeiotica.uniba.it
Telephone: +39-80-5478227 Fax: +39-80-5478232
Received: February 2, 2004
Revised: February 14, 2004
Accepted: March 13, 2004
Published online: August 15, 2004
Abstract

AIM: Gallbladder and gastrointestinal motility defects exist in gallstones patients and to a lesser extent in pigment gallstone patients. To investigated the role of gallbladder and gastrointestinal motility disorders in pigment gallstone formation in β -thalassemia major.

METHODS: Twenty-three patients with β -thalassemia major (16 females; age range 18-37 years) and 70 controls (47 females, age range 18-40 years) were studied for gallbladder and gastric emptying (functional ultrasonography), orocecal transit (OCTT, H2-breath test), autonomic dysfunction (sweat-spot, cardiorespiratory reflex tests), bowel habits, gastrointestinal symptoms and quality of life (all with questionnaires). Gallbladder content (ultrasonography) was examined before and during 8-12 mo follow-up.

RESULTS: Gallstones and/or biliary sludge were found in 13 (56%) patients. β -thalassemia major patients had increased fasting (38.0 ± 4.8 mL vs 20.3 ± 0.7 mL, P = 0.0001) and residual (7.9 ± 1.3 mL vs 5.1 ± 0.3 mL, P = 0.002) volume and slightly slower emptying (24.9 ± 1.7 min vs 20.1 ± 0.7 min, P = 0.04) of the gallbladder, together with longer OCTT (132.2 ± 7.8 min vs 99.7 ± 2.3 min, P = 0.00003) than controls. No differences in gastric emptying and bowel habits were found. Also, patients had higher dyspepsia (score: 6.7 ± 1.2 vs 4.9 ± 0.2, P = 0.027), greater appetite (P = 0.000004) and lower health perception (P = 0.00002) than controls. Autonomic dysfunction was diagnosed in 52% of patients (positive tests: 76.2% and 66.7% for parasympathetic and sympathetic involvement, respectively). Patients developing sludge during follow-up (38%, 2 with prior stones) had increased fasting and residual gallbladder volume.

CONCLUSION: Adult β -thalassemia major patients have gallbladder dysmotility associated with delayed small intestinal transit and autonomic dysfunction. These abnormalities apparently contribute together with haemolytic hyperbilirubinemia to the pathogenesis of pigment gallstones/ sludge in β -thalassemia major.

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