島田 章¹, 中井 吉英²

Akira SHIMADA¹, Yoshihide NAKAI²

¹医療法人摩利支病院心療内科, ²関西医大第1内科

¹Department of Psychosomatic Medicine, Marishi Hospital, ²First Department of Internal Medicine, School of Medicine, Kansai Univercity

キーワード : Biliary dyskinesia, Ultrasonography, Caerulein, Eggyolk, Sphincter of Oddi dysfunction

Seventeen patients with suspected biliary dyskinesia were studied ultrasonographically for gallbladder motility. The gallbladder was stimulated in two ways: using caerulein 0.2 μ/kg i. m. and using two eggyolks p. o.. The sphincter of Oddi function was investigated using spasmolytic agent, 120 mg of trepibutone in 5 subjects who showed a low response to caerulein.
(1) Abnormal contractile response was observed in 76.5% by caerulein stimulation (excessive 29.4%, low 47.1%), in 64.7% by yolks (excessive 47.1%, low 17.6%).
(2) Caerulein stimulation revealed regular and irregular contractile patterns. Irregular patterns deviated from the normal contractile curve and occurred in 29.4%. Yolk stimulation revealed four different modes of contraction: regular (11.8%), persistent (52.9%), diphasic (23.5%), and irregular (11.8%).
(3) Caerulein reproduced patient's usual symptoms in 70.6%, and yolks in 88.2%.
(4) Contractile response to caerulein coincided with that to yolks in only 41.2%.
(5) Preadministration of trepibutone significantly improved the contractility of low response subjects to caerulein. The result indicated that the difficulty in gallbladder contraction was derived from the inhibition of the sphincter of Oddi relaxation.
It appears that gallbladder motility in patients with biliary dyskinesia show abnormal responses by caerulein or yolk stimulation. We now estimate that abnormal motility of gallbladder may be caused by a primary and unknown dysfunction of the sphincter of Oddi.