tlc, I am the same person who posted as Tigerfan above. There is a study that was done in the last year by a Doctor by the name of Holes-Lewis: Here is the text:
July 10, 2009 (Toronto, Canada) � Patients with suspected biliary dyskinesia but a biliary ejection fraction above the cut-off of 35% may benefit from cholecystectomy, according to research presented here at the Society of Nuclear Medicine 56th Annual Meeting.
Cholecystokinin heptobiliary scans were employed to assess patients with suspected biliary dyskinesia presenting with abdominal pain, explained Kelly Holes-Lewis, MD, a former chief resident in the Department of Nuclear Medicine at the State University of New York in Buffalo, and now a resident in the Department of Psychiatry at the Medical University of South Carolina in Charleston.
A diagnosis of chronic acalculous cholecystitis is made in patients with an ejection fraction of less than 35%. When the ejection fraction exceeds that percentage, patients are classified as normal, explained Dr. Holes-Lewis, who conducted the research while at the State University of New York in Buffalo.
"We know a lot about patients with low gallbladder ejection fractions � specifically, below 35%," said Dr. Holes-Lewis. "There is little known about patients who have high ejection fractions � in particular, those who have high gallbladder ejection fractions of 80% or more.
"We wondered if there is something at the other end of the spectrum that is pathological that is causing the severe, debilitating symptoms that these patients are having," she told Medscape Radiology. "They typically have pain that is felt after having a fatty meal and may cause nausea and vomiting."
Patients who are suspected of having biliary dyskinesia frequently present with comorbid anxiety, noted Dr. Holes-Lewis.
She and her colleagues retrospectively analyzed 108 patients during a 1-year period who had received cholecystokinin hepatobiliary scans and had gallbladder ejection fractions of 80% or greater. Questionnaires were obtained from primary care providers about patients' symptoms, whether a cholecystectomy was performed and � if it was performed � whether symptoms improved, were partially resolved, or completely resolved. Complete data were obtained for 63 patients.
A cholecystectomy was performed in cases in which the scan was negative if there was clinically significant pain, said Dr. Holes-Lewis. She noted that the scans had ruled out the presence of any gallstones in the gallbladder.
A total of 28 (44%) of 63 patients with high ejection fractions received a cholecystectomy. Twenty-seven (97%) of 28 patients indicated that they had improvement in their symptoms after the procedure, and 22 (79%) of 28 patients said they had total resolution of their symptoms. One patient did not respond to the procedure. Investigators did not gather data on those patients who did not receive a cholecystectomy.
The data are preliminary at this point, but the findings suggest that surgery may be warranted despite a high ejection fraction, according to Dr. Holes-Lewis.
"We want to pursue this further and see if there is some pathology at the other end of the spectrum of gallbladder disorder that would be amenable to surgical correction," she said. "A lot more work needs to be done before we recommend surgical removal."
She speculated that a possible explanation is that patients might have an increased density of cholecystokinin receptors that, in response to a fatty meal, cause the gallbladder to clamp down intensely and result in pain, despite the absence of a low ejection fraction.
"It is very interesting preliminary work," said Harvey Ziessman, MD, professor of radiology in the Division of Nuclear Medicine at Johns Hopkins University in Baltimore, Maryland.
"If it is true, it will have an important clinical impact in that it's suggested that patients with hyperkinetic gallbladders get better after cholecystectomy," he said. "Most of those patients don't get referred for cholecystectomy because it's usually the patients with low gallbladder ejection fractions that get referred. We focus on the lower levels of normal. If this is correct, we have to start paying attention to the upper levels."
The research also raises the issue of neurohumoral etiology of gastrointestinal diseases, added Dr. Ziessman.
Dr. Ziessman noted that the researchers need to gather more retrospective data to confirm their findings and then consider conducting a prospective study. "They need a lot more patients and...to examine this further," he said.
The study was independently conducted. Dr. Holes-Lewis and Dr. Ziessman have disclosed no relevant financial relationships.
Society of Nuclear Medicine 56th Annual Meeting: Abstract 1312. Presented June 15, 2009.
J Nuclear Med. 2009;50:453P.
You certainly should see a doctor and ask if he knows of the study.
