| Gallbladder disease is a common condition typically | | | | community.Various ultrasound findings have been |
| affecting young and otherwise healthy individuals. Risk | | | | reported in Celiac disease, primarily in the European |
| factors include obesity, diabetes, female gender, | | | | literature. Colli et. al in Italy noted increased fasting |
| pregnancy, family history, rapid weight loss, liquid | | | | volumes of the gallbladder by ultrasound in untreated |
| protein diets, and race or ethnic background. When | | | | Celiac patients and Mariciani et. al. in the U.K. found |
| typical symptoms of right sided upper abdominal pain, | | | | increased gallbladder volumes and elevated gallbladder |
| nausea, vomiting, and bloating occur within 15-90 | | | | ejection fractions using MRI. Low CCK levels have |
| minutes of eating, especially a fatty meal, gallstones | | | | been reported in Celiac patients (Deprez et.al. 2002, |
| are usually suspected. Ultrasound of the gallbladder is | | | | Rehfeld 2004). This physician has had several Celiac |
| the first test ordered and will confirm the presence | | | | disease patients who have had high gallbladder |
| or absence of gallstones. If gallstones are confirmed | | | | ejection fractions (typically >90%) associated with |
| then surgical removal of the gallbladder is | | | | classic gallbladder symptoms that resolved after |
| recommended.However, if the ultrasound is negative | | | | gallbladder surgery. Chronic gallbladder disease was |
| or normal and gallbladder disease is still suspected a | | | | confirmed pathologically.Gallbladder disease should be |
| nuclear test called biliary scintography or more | | | | considered in Celiac disease patients despite normal |
| commonly called HIDA scan is ordered. The basis of | | | | ultrasound and HIDA tests, especially if a |
| this test is the fact that a radiolabeled chemical is | | | | "supranormal" ejection fraction is noted and pain |
| administered intravenously that is concentrated in the | | | | reproduced with CCK. Patients with abnormal high |
| liver where bile is made before being stored in the | | | | gallbladder ejection fractions should be considered as |
| gallbladder between meals. If the gallbladder is | | | | possible undiagnosed Celiacs and should undergo |
| diseased it may fail to be seen on the scan due to | | | | blood tests for Celiac disease and consideration of |
| blockage or fail to empty as expected when a | | | | upper endoscopy with small bowel biopsy.1. Fraquelli |
| hormone called cholecystokinin (CCK) is given | | | | M; Colli A; Colucci A; Bardella MT; Trovato C; Pometta |
| intravenously. CCK is present in the body and | | | | R; Pagliarulo M; Conte D. Accuracy of ultrasonography |
| released with meals to stimulate gallbladder emptying | | | | in predicting celiac disease. Arch Intern Med. 2004; |
| of bile into the intestine for digestion. Typically, the | | | | 164(2):169-74.2. Marciani L; Coleman NS; Dunlop SP; |
| gallbladder will empty a third or more of its volume | | | | Singh G; Marsden CA; Holmes GK; Spiller RC; Gowland |
| when CCK is given during a HIDA scan but usually not | | | | PA. Gallbladder contraction, gastric emptying and |
| more than 70-80%. The fraction of volume the | | | | antral motility:single visit assessment of upper GI |
| gallbladder empties is referred to as the ejection | | | | function in untreated celiac disease using echo-planar |
| fraction. A low ejection fraction is typical of a | | | | MRI. J Magn Reson Imaging. 2005; 22(5):634-8.3. |
| diseased gallbladder. Reproduction of the typical pain | | | | Deprez P; Sempoux C; Van Beers BE; Jouret A; |
| of gallbladder disease and a low ejection fraction are | | | | Robert A; Rahier J; Geubel A; Pauwels S; Mainguet P. |
| considered diagnostic of gallbladder disease in the | | | | Persistent decreased plasma cholecystokinin levels in |
| absence of gallstones and results in a | | | | celiac patients under gluten free diet:respective roles |
| recommendation that the gallbladder be removed | | | | of histological changes and nutrient hydrolysis. Regul |
| surgically.An unusual phenomenon has been observed | | | | Pept. 2002;110(1):55-634. Rehfeld JF. Clinical |
| in some Celiac patients. Gallbladder type abdominal | | | | endocrinology and metabolism. Cholecystokinin. Best |
| pain without gallstones and a "supranormal" gallbladder | | | | Pract Res Clin Endocrinol Metab. 2004; 18(4):569-86.Dr. |
| ejection fraction. Surgery relieves the gallbladder type | | | | Scot Lewey is a physician who is specialty trained |
| pain and a diseased gallbladder is found. Radiology | | | | and board certified in the field of gastroenterology |
| studies have been reported in the literature that shed | | | | (diseases of the digestive system) who practices his |
| light on this phenomenon though it's significance has | | | | specialty in Colorado. |
| been largely missed by the medical | | | | |