Gallbladder Problems Common In Celiac Disease May Be Missed By Doctors Because Of Normal Tests

Gallbladder disease is a common condition typicallycommunity.Various ultrasound findings have been
affecting young and otherwise healthy individuals. Riskreported 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, liquidvolumes of the gallbladder by ultrasound in untreated
protein diets, and race or ethnic background. WhenCeliac 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 15-90ejection fractions using MRI. Low CCK levels have
minutes of eating, especially a fatty meal, gallstonesbeen reported in Celiac patients (Deprez et.al. 2002,
are usually suspected. Ultrasound of the gallbladder isRehfeld 2004). This physician has had several Celiac
the first test ordered and will confirm the presencedisease patients who have had high gallbladder
or absence of gallstones. If gallstones are confirmedejection fractions (typically >90%) associated with
then surgical removal of the gallbladder isclassic gallbladder symptoms that resolved after
recommended.However, if the ultrasound is negativegallbladder surgery. Chronic gallbladder disease was
or normal and gallbladder disease is still suspected aconfirmed pathologically.Gallbladder disease should be
nuclear test called biliary scintography or moreconsidered in Celiac disease patients despite normal
commonly called HIDA scan is ordered. The basis ofultrasound 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 thereproduced with CCK. Patients with abnormal high
liver where bile is made before being stored in thegallbladder ejection fractions should be considered as
gallbladder between meals. If the gallbladder ispossible undiagnosed Celiacs and should undergo
diseased it may fail to be seen on the scan due toblood tests for Celiac disease and consideration of
blockage or fail to empty as expected when aupper endoscopy with small bowel biopsy.1. Fraquelli
hormone called cholecystokinin (CCK) is givenM; Colli A; Colucci A; Bardella MT; Trovato C; Pometta
intravenously. CCK is present in the body andR; Pagliarulo M; Conte D. Accuracy of ultrasonography
released with meals to stimulate gallbladder emptyingin predicting celiac disease. Arch Intern Med. 2004;
of bile into the intestine for digestion. Typically, the164(2):169-74.2. Marciani L; Coleman NS; Dunlop SP;
gallbladder will empty a third or more of its volumeSingh G; Marsden CA; Holmes GK; Spiller RC; Gowland
when CCK is given during a HIDA scan but usually notPA. Gallbladder contraction, gastric emptying and
more than 70-80%. The fraction of volume theantral motility:single visit assessment of upper GI
gallbladder empties is referred to as the ejectionfunction in untreated celiac disease using echo-planar
fraction. A low ejection fraction is typical of aMRI. J Magn Reson Imaging. 2005; 22(5):634-8.3.
diseased gallbladder. Reproduction of the typical painDeprez P; Sempoux C; Van Beers BE; Jouret A;
of gallbladder disease and a low ejection fraction areRobert A; Rahier J; Geubel A; Pauwels S; Mainguet P.
considered diagnostic of gallbladder disease in thePersistent decreased plasma cholecystokinin levels in
absence of gallstones and results in aceliac patients under gluten free diet:respective roles
recommendation that the gallbladder be removedof histological changes and nutrient hydrolysis. Regul
surgically.An unusual phenomenon has been observedPept. 2002;110(1):55-634. Rehfeld JF. Clinical
in some Celiac patients. Gallbladder type abdominalendocrinology and metabolism. Cholecystokinin. Best
pain without gallstones and a "supranormal" gallbladderPract Res Clin Endocrinol Metab. 2004; 18(4):569-86.Dr.
ejection fraction. Surgery relieves the gallbladder typeScot Lewey is a physician who is specialty trained
pain and a diseased gallbladder is found. Radiologyand 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 hasspecialty in Colorado.
been largely missed by the medical