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The Effect of Acute Oral Erythromycin on Gallbladder Motility and on Upper Gastrointestinal Symptoms in Gastrectomized Patients With and Without Gallstones: A Randomized, Placebo-Controlled Ultrasonographic Study

Portincasa, P, MD, PhD1,2; Altomare, D F, MD3; Moschetta, A, MD1,2; Baldassarre, G, MD4; Di Ciaula, A, MD1; Venneman, N G, MD1,2; Rinaldi, M, MD3; Vendemiale, G, MD1; Memeo, V, MD3; vanBerge-Henegouwen, G P, MD, PhD2; Palasciano, G, MD1

American Journal of Gastroenterology: December 2000 - Volume 95 - Issue 12 - p 3444–3451
doi: 10.1111/j.1572-0241.2000.03282.x

OBJECTIVE: Gastrectomy might be a risk factor for cholelithiasis and gallbladder stasis might play a major role. We studied fasting and postprandial gallbladder motility with 600 mg oral erythromycin or placebo in gastrectomized patients (with and without gallstones) and controls.

METHODS: Seventeen patients operated on for gastric cancer (subtotal gastrectomy: n = 10, total gastrectomy: n = 7) were compared with 20 sex- and body-size matched healthy controls. Subjects randomly received erythromycin or placebo 30 min before the ingestion of a standard 200 ml liquid test meal. Gallbladder volume was estimated by ultrasonography until 120 min after test meal. A visual analog scale monitored GI perception of appetite, satiety, nausea, abdominal fullness and epigastric pain.

RESULTS: Gastrectomized patients had increased fasting gallbladder volume (35.9 ± 3.4 ml versus 21.0 ± 1.4 ml, p= 0.0005) with faster postmeal emptying (T/2 14.8 ± 1.1 min versus 23.5 ± 1.5 min, p= 0.00019) than controls. Six patients developed small and asymptomatic gallstones, which did not influence gallbladder motility. In these patients, fasting gallbladder volume increased with time after surgery (r =+ 0.82, p= 0.047). Perception of satiety, abdominal fullness, and epigastric pain after ingestion of the test meal were all significantly greater in patients than in controls. Erythromycin significantly enhanced gallbladder emptying during fasting (p= 0.001) and postprandially in both patients and controls (0.002< p < 0.017) and significantly reduced postmeal satiety and epigastric discomfort in gastrectomized patients.

CONCLUSIONS: Increased fasting volume might be a form of stasis, predisposing patients to gallstone formation. Erythromycin improves fasting and postprandial gallbladder emptying and decreases upper GI symptoms in gastrectomized patients.

1Department of Internal Medicine and Public Medicine, Section of Internal Medicine, Bari, Italy

3Department of Emergency and Organ Transplant, Section of Surgery, University Medical School, Bari, Italy

2Department of Gastroenterology, University Hospital Utrecht, Utrecht, The Netherlands

4Division of Geriatrics, Hospital “Miulli,” Acquaviva delle Fonti, Bari, Italy

Reprint requests and correspondence: Piero Portincasa, MD, PhD, Semeiotica Medica, Section of Internal Medicine, Dept. Internal Medicine and Public Health, University Medical School, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy

Received February. 9, 2000; accepted August. 2, 2000

© The American College of Gastroenterology 2000. All Rights Reserved.
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