EFFECT OF DIABETIC AUTONOMIC NEUROPATHY ON GALL-BLADDER KINETICS IN INSULIN-DEPENDENT DIABETIC-PATIENTS

Objective: To evaluate the relationship between autonomic nervous system involvement and gall bladder contraction in insulin-dependent diabetic patients. Patients and methods: Fasting gall bladder volume and gall bladder emptying in response to a standard liquid meal were evaluated using ultrasonography in 10 normal subjects and in 35 patients with insulin-dependent diabetes: 10 without, 15 with asymptomatic and 10 with symptomatic autonomic neuropathy (AN). Gall bladder volumes were calculated from ultrasonographic images, taken during fasting and at regular intervals after a standard meal, using the sum of cylinders method. Evaluation of the presence and degree of AN was based on standard tests and clinical history. Results: In controls, the mean fasting gall bladder volume was 1 7.6 +/- 3.7 ml, while respective values for residual volume, per cent emptying and emptying rate were: 3.63 +/- 1.69 ml, 77.3 +/- 10.7% and 0.0356 +/- 0.0121 min-1. Compared with controls, diabetic patients had a slightly higher fasting gall bladder volume (19.1 +/- 5.6 ml), while values for residual volume, per cent emptying and emptying rate were significantly altered at: 9.79 +/- 5.90 ml, 50.7 +/- 18.2% and 0.0155 +/- 0.0070 min-1, respectively (P<0.01). When diabetic patients were grouped according to the degree of AN, values for fasting gall bladder volume were significantly higher in those with symptomatic AN (22.0 +/- 7.7 ml) compared with controls (P<0.05). When compared with controls, patients without AN had a significantly (P<0.01) higher residual volume (5.58 +/- 1.96 ml), a significantly lower value for per cent emptying (65.3 +/- 11.3%) and a prolonged emptying rate (0.0213 +/- 0.0055 min-1). Gall bladder motility deteriorated progressively in diabetic patients with asymptomatic and symptomatic neuropathy. In the latter group, gall bladder emptying was greatly compromised, with a residual volume of 15.22 +/- 8.10 ml, and per cent emptying and emptying rate of 32.8 +/- 19.8% and 0.0060 +/- 0.0030 min-1, respectively (P<0.01 versus controls and diabetic patients with and without asymptomatic AN). Conclusions: Impairment of gall bladder contraction in diabetic patients seems to be dependent on the presence of AN. However, the presence of an alteration in gall bladder motility in those without neuropathy suggests that other factors could also play a role in gall bladder contraction in diabetic patients.