A systemic literature review of the effect of proton pump inhibitors on gallbladder function

Objective: To determine the association between proton pump inhibitors and gallbladder function Methods: A systematic search of Medline, Embase and CENTRAL (inception to April 2020) was conducted to capture the relevant studies. A comprehensive inclusion-exclusion criterion was developed and implemented to screen the titles and abstracts. . We, however, found no eligible studies. Results: The systematic search identified 38 unique articles for title and abstract screening. Of which, five were included as potentially relevant studies. However, upon full-text screening, none of them met our inclusion criteria. This review is, therefore, an empty systematic review. Conclusion: There are no good quality studies determining the effect of proton pump inhibitors on gallbladder function. Given the common use of proton pump inhibitors and their potential impact on gallbladder function, there is an urgent need for conducting clinical studies to address this gap in the evidence.

Evaluation of Gall Bladder Volume in Type 2 Diabetes Mellitus Patients Using Real Time Ultrasonography

Background: Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Autonomic neuropathy manifests as esophageal dysfunction, nocturnal diarrhea, gall bladder dysfunction, sphincter disturbances, atonic bladder and orthostatic hypotension. The present study aimed to evaluate and compare the gall bladder volume in fasting and post prandial state by real time ultrasound in Type 2 Diabetes Mellitus (T2DM) patients and healthy controls. Subjects and Methods: In this cross sectional study, 90 subjects were included. Among them, 45 were type 2 diabetes mellitus patients included as cases and 45 age and sex matched healthy controls, who attended the Department of Medicine and Radio-diagnosis, Akash Institute of Medical Sciences & Research Centre, Devanahalli, Bengaluru, Karnaaka. All the study subjects were underwent detailed general and systemic examinations. Under aseptic conditions, 3ml fasting blood samples were collected and used for the estimation of fasting blood sugar, post prandial blood sugar. Gall bladder volume evaluation in fasting and 45 minutes post prandial (standardized fatty meal) state were done in T2DM patients and controls using real time ultrasound (GE Voluson P8 Mechine). Results: In the present study, BMI (24.78 2.31 kg/m2), FBS (160.98 27.99 mg/dl), PPBS (244.31 38.91 mg/dl), Fasting gall bladder volume (33.33 6.42 cm3), post fatty meal gall bladder volume (15.21 6.39 cm3), ejection fraction (49.34 17.29 cm3) were significantly increased in type 2 diabetes mellitus patients compared with healthy controls. Conclusion: The study results conclude that, fasting and post-prandial gallbladder volumes are indicative of gallbladder function. Patients with type 2 diabetes mellitus showed statistically significant impairment of gallbladder function. Gallbladder function may be evaluated routinely in type 2 diabetes mellitus patients.

A Whole-Food-Based Health Product (A-F Betafood®) Improves Gallbladder Function in Humans at Risk of Gallbladder Insufficiency: A Randomized, Placebo-Controlled Clinical Trial

A-F Betafood® is a whole food-based health product. The product contains phytonutrients and bioactives with antioxidant properties that may support gallbladder and liver function. Herein, we investigated the efficacy of A-F Betafood® on gallbladder and liver function. In this randomized, placebo-controlled, parallel study fifty overweight but otherwise healthy adults received A-F Betafood® or placebo for 12 weeks. Gallbladder function as assessed by gallbladder volume, ejection fraction (GBEF), ejection rate, wall thickness and liver function determined via aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltransferase, and high-sensitivity c-reactive protein analysis at baseline and week 12 were the primary outcomes. Total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, triglycerides, and oxidative stress markers including oxidized low-density lipoprotein, tumor necrosis factor-α, adiponectin and malonyldialdehyde (MDA) were assessed as secondary outcomes. A-F Betafood®-supplementation significantly reduced gallbladder wall thickness (p = 0.049) by 9% compared to placebo from baseline to week 12. The A-F Betafood® group alone had significant improvements in gallbladder volume (32%; p = 0.044) and GBEF (19%; p = 0.047) at week 12. There were no changes in liver function, oxidative stress markers or blood lipid concentrations, though MDA concentrations decreased in both groups. Our findings demonstrate A-F Betafood®-supplementation significantly improves measures of gallbladder function and support healthy gallbladder function in the individuals with gall bladder condition.

Bile Acid pool composition and Gallbladder function are controlled by TGR5 to protect the liver against Bile Acid overload

Backgrounds & AimsAs the bile acid (BA) pool composition is of major impact on liver pathophysiology, we studied its regulation by the BA receptor TGR5, promoting hepatoprotection against BA overload.MethodsWT, total and hepato-specific TGR5-KO, and TGR5-overexpressing mice were used in: partial and 90% extended hepatectomies (EH) upon normal, ursodeoxycholic acid (UDCA)- or cholestyramine (CT)-enriched diet, bile duct ligation (BDL), cholic acid (1%)-enriched diet, and TGR5 agonist (RO) treatments. We thereby studied TGR5 impact on: BA pool composition, liver injury, regeneration and survival. Particular focus was made on gut microbiota (GM) and gallbladder (GB) function analysis. BA pool composition was analyzed in patients undergoing major hepatectomy.ResultsThe TGR5-KO hyperhydrophobic BA pool was not related to BA synthesis alteration, nor to the TGR5-KO GM dysbiosis, as supported by hepatocyte-specific KO mice and cohousing experiments. The TGR5-dependent control of GB dilatation was crucial for BA pool composition, as determined by experiments including RO treatment +/− cholecystectomy. The poor TGR5-KO post-EH survival rate, related with exacerbated peribiliary necrosis and BA overload, was improved by shifting the BA pool towards a more hydrophilic composition (CT and UDCA treatments). After either BDL or CA-enriched diet +/− cholecystectomy, we found that GB dilatation had strong TGR5-dependent hepatoprotective properties. In patients, a more hydrophobic BA pool was correlated with an unfavorable outcome after hepatectomy.ConclusionBA pool composition is crucial for hepatoprotection in mice and humans. We point TGR5 as a key regulator of BA profile and thereby as a potential hepatoprotective target under BA overload conditions.Lay summaryThrough multiple in vivo experimental approaches in mice, together with a patients study, this work brings some new light on the relationships between biliary homeostasis, gallbladder function and liver protection. We showed that the bile acid pool composition is crucial for optimal liver repair, not only in mice but also in human patients undergoing major hepatectomy.