COMMENTARY
See article on page 571
Cholecystokinin infusion: assessing a rather provocative test
| The first 150 words of the full text of this article appear below. |
All gastroenterologists, whether physicians or surgeons, will
recognise a group of patients who have typical gall bladder pain but in
whom imaging of the biliary tree remains obstinately negative.
Incalculable numbers of acalculous patients, many of them middle-aged
women, end up having a cholecystectomy almost by default. The results
are surprisingly successful, perhaps owing to the powerful placebo
effect of a surgical operation. Thus "blind" cholecystectomy
relieved the pain in up to 70% of such patients in two historical
series as opposed to the 80-85% that could be anticipated in those
with symptomatic gallstones.1 2
The source of pain in
such patients may lie within the biliary tract even if it cannot be
clearly recognised. Chronic acalculous cholecystitis is the commonest
suggested cause, but its definition varies between reports and is often
not stated. Hyperplastic cholecytoses such as cholesterosis and
adenomyosis (diverticulosis) may cause symptoms that are improved by
cholecystectomy even
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- A requiem for the cholecystokinin provocation test?
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Gut 1998 43: 571-574.[Abstract] [Full Text] [PDF]
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