Impaired gallbladder motility and delayed orocecal transit contribute to pigment gallstone and biliary sludge formation in β -thalassemia major adults

Table 1 Laboratory biochemistry in β -thalassemia major patients with gallstones, biliary sludge and gallstone-free

	Gallstones	Sludge	Gallstone/ sludge-free	P
No. of subjects	7	6	10
Total bilirubin (mg/dL)	2.3 ± 0.4	1.4 ± 0.4	1.8 ± 0.3	NS
AST (U/L)	50.9 ± 11.5	32.8 ± 12.5	44.9 ± 9.7	NS
ALT (U/L)	76.7 ± 17.7	42.7 ± 19.1	59.8 ± 14.8	NS
Ferritin (mg/dL)	1 922 ± 445	1 165 ± 481	1 900 ± 372	NS
Hb (g/dL)	9.3 ± 0.1	9.5 ± 0.2	9.5 ± 0.1	NS
Iron (mg/dL)	186.8 ± 16.8	189.6 ± 8.4	156.5 ± 16.8	NS
Total proteins (g/dL)	7.8 ± 0.2	7.9 ± 0.2	7.4 ± 0.2	NS
GGT (U/L)	34.4 ± 5.6	18.3 ± 6.0	19.4 ± 4.7	NS
Alk. Phosphatase (U/L)	1.15 ± 0.2	0.98 ± 0.2	0.9 ± 0.2	NS
LDH (U/L)	331.3 ± 46.7	293.7 ± 36.7	310.7 ± 28.4	NS
Cholesterol (mg/dL)	98.3 ± 10.2	129.4 ± 12.1	96.9 ± 9.0	NS
Tryglicerides (mg/dL)	114.9 ± 23.5	71.6 ± 27.9	84.4 ± 22.0	NS

Data are expressed as mean ± SE; NS: Not significant; AST: As-partate transaminase; ALT: Alanine transaminase; GGT: Gamma-glutamyl transpeptidase; LDH: Lactate dehydrogenase.

Table 2 Dyspeptic symptoms, bowel habits and gastrointestinal motility indices (gallbladder, stomach, small bowel) in β -thalas-semia major patients with or without gallstone/sludge and in controls

	Gallstones	Sludge	GS/sludge-free	Controls	P
No. of subjects	7	6	10	70
Dyspepsia (Buckley score)	5.0 ± 1.0	6.8 ± 2.2	7.8 ± 2.5a	4.9 ± 0.2	0.046
Bowel habits (Bristol score)	3.5 ± 0.21	3.4 ± 0.6	3.8 ± 0.2	3.5 ± 0.07	NS
Stomach
Fasting antral area (cm2)	2.8 ± 0.2	2.9 ± 0.2	3.4 ± 0.3	3.2 ± 0.1	NS
Postprandial maximal area (cm2)	10.4 ± 0.2	10.7 ± 0.5	10.9 ± 0.4	11.5 ± 0.2	NS
Postprandial minimal area (%)	0.9 ± 0.5	0.3 ± 0.3	0.4 ± 0.7	2.1 ± 0.4	NS
Postprandial minimal (cm2)	2.9 ± 0.2	3.0 ± 0.2	3.3 ± 0.2	3.4 ± 0.1	NS
Half-emptying time (min)	28 ± 2	31 ± 2	28 ± 2	27 ± 1	NS
Gallbladder	30.1 ± 3.8a	42.9 ± 10.3a	40.6 ± 8.9a	20.3 ± 0.7	0.000001
Fasting volume (mL)	4.4 ± 0.9	10.0 ± 2.7ac	9.1 ± 2.3ac	5.1 ± 0.3	0.00030
Postprandial residual volume (mL)	14.7 ± 1.6a	23.0 ± 2.7	22.6 ± 2.4	24.6 ± 1.0	0.023
Postprandial residual volume (%)	21 ± 1	27 ± 5a	26 ± 2a	20 ± 1	0.009
Half-emptying time (min)	30.1 ± 3.8a	42.9 ± 10.3a	40.6 ± 8.9a	20.3 ± 0.7	0.000001
Small bowel
Orocecal transit Time (min)	128.6 ± 13.4a	30.0 ± 15.0a	136.0 ± 13.6a	99.7 ± 2.3	0.000002

Data are expressed as mean ± SE; GS: Gallstones;

^aP < 0.05 vs controls;

^cP < 0.05 vs gallstones (ANOVA and Fisher’s LSD multiple-comparison test); NS: Not significant.

Table 3 Prior gallbladder motility indices in β -thalassemia ma-jor patients according to ultrasonographic appearance of the gallbladder during 8-12 mo follow-up

	Still anechoic	Developed sludge	Prior sludge/ gallstones
No. of subjects	5	4	7
Fasting volume (mL), basal	29.2 ± 7.3	60 ± 17a	29.2 ± 4.2
Residual volume (mL), basal	5.5 ± 1.4	14.7 ± 4.6a	4.9 ± 0.9
Fasting volume at follow-up (mL)	30.9 ± 6.5	72.8 ± 20.1ac	36.7 ± 5.1

Data are expressed as mean ± SE;

^aP < 0.017 vs still anechoic group;

^cP < 0.05 vs prior sludge/gallstones group (ANOVA and Fisher’s LSD multiple comparison test).