GALLBLADDER HYPOMOTILITY

Gallbladder hypomotility provides opportunity for crystallization, aggregation of crystals, and

growth to macroscopic stones from supersaturated bile. Gallbladder hypomotility may be
determined in patients and controls by ultrasound or nuclear medicine studies of fasting
volume, ejection volume, and contracted volume. Although there is great overlap of values,
asymptomatic cholesterol gallstone patients, in general, have greater fasting and postprandial
gallbladder volume and decreased percent gallbladder emptying compared to gallstone-free
individuals.5 Greater fasting volume and decreased percent emptying of the gallbladder
persist 1 year after dissolution of stones by oral ursodeoxycholic acid therapy, suggesting that
altered gallbladder function is not necessarily caused by the stones, but may be an underlying
disorder. On the other hand, studies in animal gallstone models reveal that supersaturated bile
induces defects in contractility of gallbladder muscle, implying that motility defects may be a
result of an abnormality in bile. Gallbladder muscle from patients with cholesterol stones has
increased membrane cholesterol/phospholipid ratio and decreased membrane fluidity resulting
in impaired muscle contractility.6 These abnormalities are corrected by removing the excess
cholesterol from the plasma membranes. Gallstones and Gallbladder Disorders 25 Impaired
gallbladder emptying and increased incidence of gallstones occur in the latter part of
pregnancy, in individuals treated with oral contraceptives or somatostatin, following spinal
cord injury, with diabetes mellitus, after vagotomy, and in patients receiving long-term
parenteral nutrition. These associations suggest that alteration of gallbladder motility
contributes to gallstone formation. In none of these situations, however, is gallbladder
hypomotility likely to be the only factor leading to stone formation. For instance, patients
with severe spinal cord injury have a threefold increase in risk of gallstones, but these patients
may have disorders of gastric, duodenal, and colonic motility; dietary changes; muscle
atrophy; and weight loss, in addition to decreased gallbladder motility.