Gall bladder dysfunction in chronic diabetics (type 2): an ultrasonography based prospective study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20160084Keywords:
Chronic diabetics, Fasting gall bladder volume, Percentage of contraction, Ultrasonography, Cholelithiasis, Cholecystitis, Autonomic neuropathyAbstract
Background: Type 2 diabetes mellitus is commonest endocrine disorder now a days and its prevalence is continuously rising in India due to spread of modern life style so its associated complications are also increasing. Gall bladder is one of the commonly affected organs in chronic diabetics, most probably due to autonomic neuropathy which adversely affects gall bladder motility and provokes bile stasis.
Methods: This institution based prospective study had been performed among 100 chronic diabetics; randomly selected from diabetic clinic of department of medicine, people’s college of medical science and research centre, Bhopal M.P. India. Only those patients selected for study who have type 2 diabetes mellitus more than 5 yr and have well controlled sugar levels. 100 controls/volunteers were selected for comparative evaluation. All patients and volunteers had undergone abdominal ultrasonography for any existing hepatobiliary pathology and to measure fasting and post fatty meal gall bladder volume.
Results: Among 100 chronic diabetics seventy-six (76%) patients didn’t show any hepatobiliary abnormality however cholelithiasis was seen in thirteen (13%) patients, cholecystitis in five (5%) patients and sludge was seen in six (6%) patients. In group of 100 controls ninety-one (91%) didn’t show any hepatobiliary pathology however cholelithiasis was detected incidentally in four (4%) persons, cholecystitis in two (2%) persons and sludge in three (3%) persons. Significant difference is observed in fasting gall bladder volume of chronic diabetics and controls (p value- 0.001). Major difference is also observed in percentage of gall bladder contraction among chronic diabetics and controls (p value- 0.001).
Conclusions: Higher fasting gall bladder volume and decreased percentage of contraction both are observed in patients of chronic diabetes mellitus attributed to autonomic neuropathy. Prolonged stasis of bile leads to complications e.g. cholelithiasis, cholecystitis and sludge deposition as late outcome. Hepatobiliary ultrasonography in chronic diabetics can be used as screening tool for early diagnosis of complication and to avoid its serious consequences when presents in emergency and undergone for surgery.
References
Agarwal AK, Miglani S, Singla S, Garg U, Dudeja RK, Goel A. Ultrasonographic evaluation of gall bladder volume in diabetics. JAPI. 2004;52:962-5.
Gitelson J, Schwartz A, Frankel M. Gallbladder dysfunction in diabetes mellitus. The diabetic neurogenic gallbladder. Diabetes. 1963;12:308-12.
Singh S, Chander R, Singh A, Mann S. Ultrasonographic evaluation of gall bladder diseases in diabetes mellitus type 2. Indian Journal of Radiology and Imaging. 2006;16(4):505.
Shaffer EA. Epidemiology of gallbladder stone disease. Best Practice & Research Clinical Gastroenterology. 2006;20(6):981-96.
Haffner SM, Diehl AK, Valdez R, Mitchell BD, Hazuda HP, Morales P, et al. Clinical Gallbladder Disease in NIDDM Subjects: Relationship to duration of diabetes and severity of glycemia. Diabetes Care. 1993;16(9):1276-84.
Chapman BA, Chapman TM, Frampton CM, Chisholm RJ, Allan RB, Wilson IR, et al. Gallbladder Volume (Comparison of Diabetics and Controls). Digestive diseases and sciences. 1998;43(2):344-8.
Palasciano G, Portincasa P, Belfiore A, Baldassarre G, Cignarelli M, Paternostro A. Gallbladder volume and emptying in diabetics: the role of neuropathy and obesity. Journal of internal medicine. 1992;231(2):123-7.
Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. British medical journal (Clinical research ed.). 1982;285(6346):916.
Kayacetin E, Kisakol G, Kaya A, Akpinar Z. Real-time sonography for screening of gallbladder motility in diabetic patients: relation to autonomic and peripheral neuropathy. Neuroendocrinology Letters. 2003;24(1/2):73-6.
Everson GT, Braverman DZ, Johnson ML, Kern F. A critical evaluation of real-time ultrasonography for the study of gallbladder volume and contraction. Gastroenterology. 1980;79(1):40-6.
Jorgensen T. Gall stones in a Danish population. Relation to weight, physical activity, smoking, coffee consumption, and diabetes mellitus. Gut. 1989;30(4):528-34.
Chapman BA, Chapman TM, Frampton CM, Chisholm RJ, Allan RB, Wilson IR, et al. Gallbladder Volume (Comparison of Diabetics and Controls). Digestive diseases and sciences. 1998;43(2):344-8.
Raman PG, Patel A, Mathew V. Gallbladder disorders and type 2 diabetes mellitus--a clinic-based study. The Journal of the Association of Physicians of India. 2002;50:887-90.
Gaur C, Mathur A, Agarwal A, Verma K, Jain R, Swaroop A. Diabetic autonomic neuropathy causing gall bladder dysfunction. The Journal of the Association of Physicians of India. 2000;48(6):603-5.
Public health foundation of India. Internet; http://ccebdm.org/news.php [cited on 26 nov. 2015].
DECODA Study Group. Age-and sex-specific prevalence of diabetes and impaired glucose regulation in 11 Asian cohorts. Diabetes care. 2003;26(6):1770-80.
Kumar A, Attaluri A, Hashmi S, Schulze KS, Rao SS. Visceral hypersensitivity and impaired accommodation in refractory diabetic gastroparesis. Neurogastroenterology & Motility. 2008;20(6):635-42.
Kato I, Nomura A, Stemmermann GN, Chyou PH. Prospective study of clinical gallbladder disease and its association with obesity, physical activity, and other factors. Digestive diseases and sciences. 1992;37(5):784-90.
Hahm JS, Park JY, Park KG, Ahn YH, Lee MH, Park KN. Gallbladder motility in diabetes mellitus using real time ultrasonography. The American journal of gastroenterology. 1996;91(11):2391-4.
Sharma MP, Saraya A, Anand AC, Karmarkar MG. Gallbladder dysmotility in diabetes mellitus - an ultrasound study. Trop Gastroenterol. 1995;16:13-8.
Bucceri AM, Brogna A, Ferrara R. Sonographic study of postprandial gallbladder emptying and common bile duct changes in patients with diabetes or cholelithiasis. Abdominal imaging. 1994;19(5):427-9.
Fraquelli M, Pagliarulo M, Colucci A, Paggi S, Conte D. Gallbladder motility in obesity, diabetes mellitus and coeliac disease. Digestive and liver disease. 2003;35:12-6.
Fiorucci S, Bosso R, Scionti L, Disanto S, Annibale B, Fave DG. Neurohumoral control of gallbladder motility in healthy subjects and diabetic patients with or without autonomic neuropathy. Digestive diseases and sciences. 1990;35(9):1089-97.
Kayacetin E, Kisakol G, Kaya A, Akpinar Z. Real-time sonography for screening of gallbladder motility in diabetic patients: relation to autonomic and peripheral neuropathy. Neuroendocrinology Letters. 2003;24(1/2):73-6.
Várkonyi TT, Lengyel C, Madácsy L, Velösy B, Kempler P, Fazekas T, et al. Gallbladder hypomotility in diabetic polyneuropathy. Clinical Autonomic Research. 2001;11(6):377-81.
De Boer SY, Masclee AA, Lamers CB. Effect of hyperglycemia on gastrointestinal and gallbladder motility. Scandinavian Journal of Gastroenterology. 1992;27(S194):13-8.
Shaw SJ, Hajnal F, Lebovitz Y, Ralls P, Bauer M, Valenzuela J, et al. Gallbladder dysfunction in diabetes mellitus. Digestive diseases and sciences. 1993;38(3):490-6.
Braverman DZ. The lack of effect of metoclopramide on gallbladder volume and contraction in diabetic cholecystoparesis. The American journal of gastroenterology. 1986;81(10):960-2.
Dhiman RK, Arke L, Bhansali A, Gupta S, Chawla YK. Cisapride improves gallbladder emptying in patients with type 2 diabetes mellitus1. Journal of gastroenterology and hepatology. 2001;16(9):1044-50.
Annese V, Bassotti G, Caruso N, De Cosmo S, Gabbrielli A, Modoni S, et al. Gastrointestinal motor dysfunction, symptoms, and neuropathy in noninsulin-dependent (type 2) diabetes mellitus. Journal of clinical gastroenterology. 1999;29(2):171-7.
Xynos E, Tsiaoussis J, Epanomeritakis E, Glynos M, Haroulakis N, Vassilakis JS. Effect of oral cisapride on gallbladder emptying during fasting and postprandial states. Academic radiology. 1998;5(2):115-8.
Morali GA, Braverman DZ, Lissi J, Goldstein R, Jacobsohn WZ. Effect of clonidine on gallbladder contraction and small bowel transit time in insulin-treated diabetics. The American journal of gastroenterology. 1991;86(8):995-9.
Jain A, Paranjape S. Prevalence of type 2 diabetes mellitus in elderly in a primary care facility: An ideal facility. Indian journal of endocrinology and metabolism. 2013;17: S318.
Wilson IR, Hurrell MA, Pattinson NR, Chapman BA. The effect of simvastatin and bezafibrate on bile composition and gall‐bladder emptying in female non‐insulin‐dependent diabetics. Journal of gastroenterology and hepatology. 1994;9(5):447-51.
