Cholecystokinin and cholecystokinin-A receptor: An attractive treatment strategy for biliary dyskinesia?

Biliary dyskinesia is a relatively common gastrointestinal disease that is increas-ing in incidence as living standards improve.However,its underlying pathogenesis remains unclear,hindering the development of therapeutic drugs.Recently,“Expression and functional study of cholecystokinin-A receptors on the interstitial Cajal-like cells of the guinea pig common bile duct”demonstrated that cholecystokinin(CCK)regulates the contractile function of the common bile duct through interaction with the CCK-A receptor in interstitial Cajal-like cells,contributing to improving the academic understanding of biliary tract dynamics and providing emerging directions for the pathogenesis and clinical management of biliary dyskinesia.This letter provides a brief overview of the role of CCK and CCK-A receptors in biliary dyskinesia from the perspective of animal experiments and clinical studies,and discusses prospects and challenges for the clinical application of CCK and CCK-A receptors as potential therapeutic targets.

A retrospective cohort study to examine the association between the persistence of abdominal pain after cholecystectomy and ejection fraction on HIDA scan in patients with biliary dyskinesia

Background and aims:The persistence of pain in patients who underwent cholecystectomy primarily for biliary dyskinesia has been associated with gall bladder ejection fraction(GBEF)found on hepatobiliary iminodiacetic acid(HIDA)scan.Cholecystectomy is a definitive treatment for cholelithiasis but is questionable in biliary dyskinesia.During the postoperative follow-up,gastroenterologists and surgeons often found that some patients with biliary dyskinesia continue to experience biliary pain even after surgery.This study aims to investigate whether the value of GBEF found on the HIDA scan predicts the persistence of pain after cholecystectomy in patients with biliary dyskinesia(EF<35%on HIDA scan).Methods:It is a retrospective cohort study conducted at Kern Medical by recruiting patients from November 2019 to October 2022 in consecutive manner.It is a single sample study consisting of post-cholecystectomy biliary dyskinesia patients with dichotomous outcomes,i.e.,persistent typical recurrent epigastric or right upper quadrant pain with/without meals versus no pain.The primary outcome was the presence of pain 30 days after the cholecystectomy.Univariate analysis was performed with some of the bivariate indicators and continuous predictors,which contained fewer missing elements and had more variation.Results:Univariate logistic regression suggested that HIDA GBEF as a continuous variable does not suggest a relationship with pain after surgery(p=0.3951).A ROC analysis suggested a cutoff of HIDA GBEF=16(AUC=0.60,Specificity=0.5455,Sensitivity=0.7333).Conclusion:Our study does not support the relationship between GBEF found on HIDA scan to improved outcomes after the surgery.But larger controlled trials comparing outcomes of the patients with biliary dyskinesia who did and didn't undergo cholecystectomy are needed to look for other factors.

HIDA scan for functional gallbladder disorder： ensure that you know how the scan was done

BACKGROUND： Despite the increasing use of fatty meal（FM） as a substitute for cholecystokinin（CCK） in pain reproduction during hepato-imino-diacetic acid（HIDA） scan in functional gallbladder disorder, there are no studies comparing the differences between CCK and FM. The present study was to compare the efficacy of FM in comparison of CCK in FGBD application. METHODS： Patients undergoing HIDA scans from August 2013 to May 2014 were divided into two groups： those undergoing CCK-stimulated HIDA scan versus FM-stimulated HIDA scan. These groups were compared according to demographics and HIDA results.RESULTS： Of 153 patients, 70 received CCK and 83 FM. There was no difference regarding age, gender, gallstones, gallbladder ejection fraction and time to visualization. However, significantly more of the patients receiving CCK than FM experienced pain reproduction（61% vs 30%, P〈0.01）.CONCLUSIONS： Stimulation of gallbladder contractility with a FM during HIDA is less than half as likely to reproduce biliary symptoms compared to CCK, despite similar ejection fractions and other parameters. It is essential that providers account for this difference when counseling patients regarding cholecystectomy for functional gallbladder disorder.