Impacts of factors secondary to portal hypertension on gall bladder motility in chronic hepatitis B induced liver disease

ABSTRACTImpacts of factors secondary to portal hypertension on gall bladder motility in chronic hepatitis B induced liver diseaseObjective: Gallbladder motility diminishes in chronic liver diseases. However, the mechanism of this impairment has not been clear yet. In this study, it was aimed to assess the effects of factors secondary to portal hypertension (ascites, umbilical vein patency, splenomegaly, portal gastropathy, varices, portal vein diameter, portal hemodynamic parameters, etc. ) on gall bladder motility and to observe influence of portal gastropathy on antrum wall thickness and stomach contractions in patients with chronic hepatitis B.Material and Methods: A total of 30 patients followed-up with chronic hepatitis B not meeting exclusion criteria were included in this study. Patients generated two groups with the first one being formed by 10 patients with no portal hypertensive signs while the second one included 20 cirrhotic patients with clinically overt portal hypertension. Those withdiabetes mellitus, obesity, hyperlipidemia, gastric or ileal resection, heart failure, pancreatitis, non-liver organ failure, cancer and with stonemalformation or polyps in gallbladdder were kept out of the study. Parameters concerning liver failure were obtained by screening archive files. Test meal contained 375 kcal with carbohydrate, protein and lipidsrates being 26%, 19% and 55%, respectively. Wall thickness, longitude, height and width of gall bladder along with stomach wall thickness were measured with ultrasound before and after test meal at 15, 30, 60, 90 and 120 minutes following standart test meal. Volume and ejection fraction of gallbladder were calculated using aforementioned parameters. Data were analyzed using SPSS version 15.Results: 21 (79%) of patients were male while 9 (30%) were female.Mean age of all patients was 51+/-13 years while that of those10 with chronic hepatitis B and 20 with cirrhosis were 40+/-12 and 56+/-11, respectively; indicating a statistically significant difference (p=0.001). Ascites was detected in 9 patients in cirrhosis group despite no patients with ascites was noted in HBV group. A statistically significant differencewas noted in cirrhotic group concerning presence of splenomegaly, palmar erythema, ascites, irregular liver structure and sharp liver (p<0,05). No significant difference was observed when comparing volume and ejection fraction of gall bladders of patients included in the study (p>0,05). It wasshown in patients with portal hypertension that antral wall thickness increased significantly in 15, 30 and 120 minutes while that of gallbladder did in 30 and 90 minutes. Besides, presence of significant alterations in wall thickness of gallbladder and antrum over time was detected in both groups (p=0,0001). However, it was also noted in both groups that volume changes of gallbladder diminished over time with statictical significance while vice versa was shown concerning ejection fraction; indicating a significant increase over time (p=0,0001). No correlation was observed between the groups regarding alteration rates of wall thickness of gallbladder and antrum, volume of gallbladder and ejection fraction over time.Key Words: Chronic hepatitis B, gallbladder motility, portal hypertension, ultrasonography