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

Cancer is a common disease that affects young people and other healthy people. Risk factors include obesity, diabetes, gender, pregnancy, family history, rapid weight loss, water protein intake, and race and ethnicity. When symptoms of upper right abdominal pain, nausea, vomiting, and bloating occur within 15-90 minutes after eating, especially fatty foods, stones are suspected. . Ultrasound of the gallbladder is the first test that determines the presence or absence of stones. If gallstones are established it is recommended to remove the gallbladder.

However, if the ultrasound is negative or normal, and the disease of the gallbladder is still suspected, a nuclear test called biliary scintography, also known as HIDA scan. The basis of this test is the fact that a radioactive substance is given in the blood that is concentrated in the liver where the liver is made before being treated in the gallbladder between meals. If the gallbladder is diseased it may not show up on a scan because it is blocked or may not empty when a hormone called cholecystokinin (CCK) is given. CCK is present in the body and is given with food to stimulate the gallbladder to move into the intestine for digestion. Usually, the gallbladder will release three or more of its volume when CCK is released during HIDA but usually no more than 70-80%. The fraction of the volume that is expelled from the gallbladder is called the ejection fraction. A small fraction of the expulsion is indicative of cancer. Reproduction of typical gallbladder pain and low ejection fraction is considered a diagnosis of gallbladder disease in the absence of gallstones and a recommendation for surgical removal of the gallbladder.

An unusual situation has been observed in some Celiac patients. Abdominal pain without stones and “supranormal” fraction. Surgery can relieve the type of gallbladder pain that is diagnosed with gallbladder disease. Radiological studies have appeared in the literature explaining this phenomenon although its importance has been lost by the medical community.

Several ultrasound findings have been reported for Celiac disease, in the European literature. Colli et. al in Italy observed an increase in fasting volumes of the gallbladder by ultrasound in Celiac patients and Mariciani et. al. in the UK showed increased gallbladder volumes and increased gallbladder ejection fractions using MRI. Low CCK levels have been shown in Celiac patients (Deprez et.al. 2002, Rehfeld 2004). This physician has many Celiac disease patients with large gallbladder ejection fractions (typically 90%) associated with classic gallbladder symptoms that resolve after gallbladder surgery. Chronic gallbladder disease was confirmed.

Celiac disease should be considered in patients with Celiac disease regardless of X-ray and HIDA tests, especially if a “supranormal” fraction is found and causes pain in the CCK. Patients with high gallbladder emptying fractions are considered undiagnosed Celiacs and should undergo blood tests for Celiac disease and consider upper endoscopy and small bowel biopsy.

1. Fraquelli M; Colli A; Colucci A; Bardella MT; Trovato C; Pometta R; Pagliarulo M; Conte D. Accuracy of ultrasonography in predicting celiac disease. Arch Intern Med. 2004; 164(2):169-74.

2. Marciani L; Coleman NS; Dunlop SP; Singh G; Marsden CA; Holmes GK; RC Owners; Gowland PA. Gastric emptying, gastric emptying and antral motility: single visit assessment of upper GI function in untreated celiac disease using echo-planar MRI. J Magn Reson Imaging. 2005; 22(5):634-8.

3. Deprez P; Sempoux C; Van Beers BE; Jouret A; Robert A; Rahier J; Keubere A; Pauwels S; Mainguet P. Persistent decrease of cholecystokinin plasma levels in celiac patients under gluten-free diet: whether the roles of histological changes and nutrient deficiency. Regul Pept. 2002;110(1):55-63

4. Rehfeld JF. Clinical endocrinology and metabolism. Cholecystokinin. Best Practices Clin Endocrinol Metab. 2004; 18(4):569-86.

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