Sonographic evaluation of gallbladder motility in children with chronic functional constipation

Distribution changes of interstitial cells of Cajal during cholesterol gallstone formation in guinea pigs fed a high cholesterol diet

BACKGROUND

Cholesterol gallstone is commonly observed in patients with gallbladder disorders. Interstitial cells of Cajal (ICCs) in the gallbladder are important for regulating gallbladder motility and have a close relationship with cholelithiasis.

AIM

The aim of this study was to explore changes in the distribution of gallbladder ICCs during cholesterol gallstone formation.

MATERIALS AND METHODS

Thirty guinea pigs were randomly divided into three groups: the control group and study groups. Animals in study groups were fed on high cholesterol diet for 4 weeks or 8 weeks. Animals in the control groups were fed on a standard diet for 8 weeks. Immunohistochemistry was performed to observe the shape, size, morphology, and numbers of ICCs from the neck of the gallbladder to the fundus of the gallbladder, and terminal deoxynucleotidyl transferase dUTP nick-end labeling was performed to detect apoptosis in ICCs from the upper part of the gallbladder to the lower part of the gallbladder.

RESULTS

There were no differences in the shape, size, and morphology of the gallbladder ICCs in all groups. Cholesterol gallstones formed in guinea pigs fed on high cholesterol diet. The numbers of gallbladder ICCs were significantly decreased from the neck of the gallbladder to the fundus of the gallbladder, and gallbladder ICC apoptosis was significantly increased from the upper part of the gallbladder to the lower part of the gallbladder in both guinea pigs fed on high cholesterol diet (all P<0.05).

CONCLUSION

Cholesterol gallstone formation reduced the density of gallbladder ICCs and increased the frequency of apoptotic gallbladder ICCs from the neck of the gallbladder to the fundus of the gallbladder, and these alterations may affect gallbladder ICC function.

Decision-making patterns in managing children with suspected biliary dyskinesia

AIM

To explore and to analyze the patterns in decision-making by pediatric gastroenterologists in managing a child with a suspected diagnosis of functional gallbladder disorder (FGBD).

METHODS

The questionnaire survey included a case history with right upper quadrant pain and was sent to pediatric gastroenterologists worldwide via an internet list server called the PEDGI Bulletin Board.

RESULTS

Differences in decision-making among respondents in managing this case were observed at each level of investigations and management. Cholecystokinin-scintigraphy scan (CCK-CS) was the most common investigation followed by an endoscopy. A proton pump inhibitor was most commonly prescribed treating the condition. The majority of respondents considered a referral for a surgical evaluation when CCK-CS showed a decreased gallbladder ejection fraction (GBEF) value with biliary-type pain during CCK injection.

CONCLUSION

CCK infusion rate in CCK-CS-CS and GBEF cut-off limits were inconsistent throughout practices. The criteria for a referral to a surgeon were not uniform from one practitioner to another. A multidisciplinary team approach with pediatric gastroenterologists and surgeons is required guide the decision-making managing a child with suspected FGBD. ​

Atractylodes macrocephala for treatment of functional constipation: Underlying mechanisms

Functional constipation is a common and frequently-occurring disease, and Atractylodes macrocephala has its unique advantages in treating functional constipation. This paper review recent progress in the treatment of functional constipation with Atractylodes macrocephala and the underlying mechanism, with an aim to provide a theoretical basis for clinical treatment of functional constipation with Atractylodes macrocephala, and guidance of the mechanism research in the future.