| Gallbladder disease is a common condition typically | | | | ultrasound findings have been reported in Celiac |
| affecting young and otherwise healthy individuals. | | | | disease, primarily in the European literature. Colli et. |
| Risk factors include obesity, diabetes, female | | | | al in Italy noted increased fasting volumes of the |
| gender, pregnancy, family history, rapid weight | | | | gallbladder by ultrasound in untreated Celiac |
| loss, liquid protein diets, and race or ethnic | | | | patients and Mariciani et. al. in the U.K. found |
| background. When typical symptoms of right | | | | increased gallbladder volumes and elevated |
| sided upper abdominal pain, nausea, vomiting, and | | | | gallbladder ejection fractions using MRI. Low CCK |
| bloating occur within 15-90 minutes of eating, | | | | levels have been reported in Celiac patients |
| especially a fatty meal, gallstones are usually | | | | (Deprez et.al. 2002, Rehfeld 2004). This physician |
| suspected. Ultrasound of the gallbladder is the first | | | | has had several Celiac disease patients who have |
| test ordered and will confirm the presence or | | | | had high gallbladder ejection fractions (typically |
| absence of gallstones. If gallstones are confirmed | | | | >90%) associated with classic gallbladder |
| then surgical removal of the gallbladder is | | | | symptoms that resolved after gallbladder surgery. |
| recommended.However, if the ultrasound is | | | | Chronic gallbladder disease was confirmed |
| negative or normal and gallbladder disease is still | | | | pathologically.Gallbladder disease should be |
| suspected a nuclear test called biliary scintography | | | | considered in Celiac disease patients despite |
| or more commonly called HIDA scan is ordered. | | | | normal ultrasound and HIDA tests, especially if a |
| The basis of this test is the fact that a | | | | "supranormal" ejection fraction is noted and pain |
| radiolabeled chemical is administered intravenously | | | | reproduced with CCK. Patients with abnormal high |
| that is concentrated in the liver where bile is | | | | gallbladder ejection fractions should be considered |
| made before being stored in the gallbladder | | | | as possible undiagnosed Celiacs and should |
| between meals. If the gallbladder is diseased it | | | | undergo blood tests for Celiac disease and |
| may fail to be seen on the scan due to blockage | | | | consideration of upper endoscopy with small |
| or fail to empty as expected when a hormone | | | | bowel biopsy.1. Fraquelli M; Colli A; Colucci A; |
| called cholecystokinin (CCK) is given intravenously. | | | | Bardella MT; Trovato C; Pometta R; Pagliarulo M; |
| CCK is present in the body and released with | | | | Conte D. Accuracy of ultrasonography in |
| meals to stimulate gallbladder emptying of bile into | | | | predicting celiac disease. Arch Intern Med. 2004; |
| the intestine for digestion. Typically, the gallbladder | | | | 164(2):169-74.2. Marciani L; Coleman NS; Dunlop |
| will empty a third or more of its volume when | | | | SP; Singh G; Marsden CA; Holmes GK; Spiller RC; |
| CCK is given during a HIDA scan but usually not | | | | Gowland PA. Gallbladder contraction, gastric |
| more than 70-80%. The fraction of volume the | | | | emptying and antral motility:single visit assessment |
| gallbladder empties is referred to as the ejection | | | | of upper GI function in untreated celiac disease |
| fraction. A low ejection fraction is typical of a | | | | using echo-planar MRI. J Magn Reson Imaging. |
| diseased gallbladder. Reproduction of the typical | | | | 2005; 22(5):634-8.3. Deprez P; Sempoux C; Van |
| pain of gallbladder disease and a low ejection | | | | Beers BE; Jouret A; Robert A; Rahier J; Geubel A; |
| fraction are considered diagnostic of gallbladder | | | | Pauwels S; Mainguet P. Persistent decreased |
| disease in the absence of gallstones and results in | | | | plasma cholecystokinin levels in celiac patients |
| a recommendation that the gallbladder be | | | | under gluten free diet:respective roles of |
| removed surgically.An unusual phenomenon has | | | | histological changes and nutrient hydrolysis. Regul |
| been observed in some Celiac patients. Gallbladder | | | | Pept. 2002;110(1):55-634. Rehfeld JF. Clinical |
| type abdominal pain without gallstones and a | | | | endocrinology and metabolism. Cholecystokinin. |
| "supranormal" gallbladder ejection fraction. Surgery | | | | Best Pract Res Clin Endocrinol Metab. 2004; |
| relieves the gallbladder type pain and a diseased | | | | 18(4):569-86.Dr. Scot Lewey is a physician who is |
| gallbladder is found. Radiology studies have been | | | | specialty trained and board certified in the field of |
| reported in the literature that shed light on this | | | | gastroenterology (diseases of the digestive |
| phenomenon though it's significance has been | | | | system) who practices his specialty in Colorado. |
| largely missed by the medical community.Various | | | | |