Gallbladder dysfunction in diabetes mellitus. The influence of diabetic neuropathy and hypersomatostatinemia.:The Influence of Diabetic Neuropathy and Hypersomatostatinemia
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In order to determine whether diabetes mellitus is a high risk factor for cholelithiasis, abdominal sonographic examination was performed to screen for cholelithiasis in 176 diabetics and 241 non-diabetic controls. The incidence of cholelithiasis was higher in diabetcis than in non-diabetics (17.6% vs. 7.5 %). Then gallbladder contractility was investigated to determine the possible mechanism of development of cholelithiasis in diabetics. The gallbladder contractile rate was estimated by using real-time ultrasonography to measure the changes in the size of the gallbladder after oral egg-yolk administration or intramuscular injection of caerulein. Sixty minutes after egg-yolk loading, the gallbladder contracted gradually by 57.0% and 55.9% respection in 10 non-diabetics and 9 diabetics without any signs of diabetic neuropathy. In 8 diabetics with neuropathy, the contractility was reduced (34.9% at 60 min). With caerulein injection in 9 non-diabetcis, the gallbladder contracted by 61.3% at 30 min and then dilated gradually. In 7 diabetics without neuropathy it contracted well but did not dilate thereafter. In 10 diabetics with neuropathy, it either contracted poorly or remained uncontracted.<BR>Since patients with somatostatinoma are known to have both diabetes and cholelithiasis, the relationship between somatostatin concentration in plasma and gallbladder contraction was investigated in diabetics. With high doses (50 ng/min/kg) of somatostatin infusion, contraction of the gallbladder by egg-yolk or caerulein was completely inhibited in 10 healthy volanteers. With low doses (1 ng/min/kg) of somatostatin infusion, gallbladder contraction by caerulein injection was inhibited in three of five normal volanteers, even when the palsma levels of somatostatin remained at about 20-30 pg/m<I>l</I>. Moreover, the plasma somatostatin levels in a few diabetics were about 20-30 pg/m<I>l</I>.<BR>In conclusion, the high incidence of cholelithiases in diabetics seems to be due to reduced gallbladder contraction which is related to diabetic neuropathy and/or to incrased plasma levels of somatostatin.
- 一般社団法人 日本糖尿病学会の論文
一般社団法人 日本糖尿病学会 | 論文
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