| Gallbladder disease is a common condition typically | | | | the medical community. |
| affecting young and otherwise healthy individuals. | | | | Various ultrasound findings have been reported in |
| Risk factors include obesity, diabetes, female | | | | Celiac disease, primarily in the European literature. |
| gender, pregnancy, family history, rapid weight | | | | Colli et. al in Italy noted increased fasting volumes |
| loss, liquid protein diets, and race or ethnic | | | | of the gallbladder by ultrasound in untreated Celiac |
| background. When typical symptoms of right | | | | patients and Mariciani et. al. in the U.K. found |
| sided upper abdominal pain, nausea, vomiting, and | | | | increased gallbladder volumes and elevated |
| bloating occur within 15-90 minutes of eating, | | | | gallbladder ejection fractions using MRI. Low CCK |
| especially a fatty meal, gallstones are usually | | | | levels have been reported in Celiac patients |
| suspected. Ultrasound of the gallbladder is the first | | | | (Deprez et.al. 2002, Rehfeld 2004). This physician |
| test ordered and will confirm the presence or | | | | has had several Celiac disease patients who have |
| absence of gallstones. If gallstones are confirmed | | | | had high gallbladder ejection fractions (typically |
| then surgical removal of the gallbladder is | | | | >90%) associated with classic gallbladder |
| recommended. | | | | symptoms that resolved after gallbladder surgery. |
| However, if the ultrasound is negative or normal | | | | Chronic gallbladder disease was confirmed |
| and gallbladder disease is still suspected a nuclear | | | | pathologically. |
| test called biliary scintography or more commonly | | | | Gallbladder disease should be considered in Celiac |
| called HIDA scan is ordered. The basis of this test | | | | disease patients despite normal ultrasound and |
| is the fact that a radiolabeled chemical is | | | | HIDA tests, especially if a "supranormal" ejection |
| administered intravenously that is concentrated in | | | | fraction is noted and pain reproduced with CCK. |
| the liver where bile is made before being stored in | | | | Patients with abnormal high gallbladder ejection |
| the gallbladder between meals. If the gallbladder is | | | | fractions should be considered as possible |
| diseased it may fail to be seen on the scan due | | | | undiagnosed Celiacs and should undergo blood |
| to blockage or fail to empty as expected when a | | | | tests for Celiac disease and consideration of upper |
| hormone called cholecystokinin (CCK) is given | | | | endoscopy with small bowel biopsy. |
| intravenously. CCK is present in the body and | | | | 1. Fraquelli M; Colli A; Colucci A; Bardella MT; |
| released with meals to stimulate gallbladder | | | | Trovato C; Pometta R; Pagliarulo M; Conte D. |
| emptying of bile into the intestine for digestion. | | | | Accuracy of ultrasonography in predicting celiac |
| Typically, the gallbladder will empty a third or | | | | disease. Arch Intern Med. 2004; 164(2):169-74. |
| more of its volume when CCK is given during a | | | | 2. Marciani L; Coleman NS; Dunlop SP; Singh G; |
| HIDA scan but usually not more than 70-80%. | | | | Marsden CA; Holmes GK; Spiller RC; Gowland PA. |
| The fraction of volume the gallbladder empties is | | | | Gallbladder contraction, gastric emptying and antral |
| referred to as the ejection fraction. A low | | | | motility:single visit assessment of upper GI |
| ejection fraction is typical of a diseased gallbladder. | | | | function in untreated celiac disease using |
| Reproduction of the typical pain of gallbladder | | | | echo-planar MRI. J Magn Reson Imaging. 2005; |
| disease and a low ejection fraction are considered | | | | 22(5):634-8. |
| diagnostic of gallbladder disease in the absence of | | | | 3. Deprez P; Sempoux C; Van Beers BE; Jouret |
| gallstones and results in a recommendation that | | | | A; Robert A; Rahier J; Geubel A; Pauwels S; |
| the gallbladder be removed surgically. | | | | Mainguet P. Persistent decreased plasma |
| An unusual phenomenon has been observed in | | | | cholecystokinin levels in celiac patients under gluten |
| some Celiac patients. Gallbladder type abdominal | | | | free diet:respective roles of histological changes |
| pain without gallstones and a "supranormal" | | | | and nutrient hydrolysis. Regul Pept. |
| gallbladder ejection fraction. Surgery relieves the | | | | 2002;110(1):55-63 |
| gallbladder type pain and a diseased gallbladder is | | | | 4. Rehfeld JF. Clinical endocrinology and |
| found. Radiology studies have been reported in | | | | metabolism. Cholecystokinin. Best Pract Res Clin |
| the literature that shed light on this phenomenon | | | | Endocrinol Metab. 2004; 18(4):569-86. |
| though it's significance has been largely missed by | | | | |