Impaired Gallbladder Motility and Increased Gallbladder Wall Thickness in Patients with Nonalcoholic Fatty Liver Disease

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Along with the increase in the incidence of NAFLD and associated obesity, an increase in gallbladder disease (GD) has been noted. This has led to the identification of a new disease entity called fatty GD. There is a gap in the literature on the dynamics of gallbladder function in patients with NAFLD. METHODS: An observational case-control study, a total of 50 patients with biopsy proven NAFLD without gallbladder stone/sludge and 38 healthy comparison subjects were enrolled. Fasting, postprandial gallbladder volumes (PGV), gallbladder ejection fraction (GEF), and fasting gallbladder wall thickness (FGWT) were measured by real-time 2-dimensional ultrasonography. RESULTS: Fasting gallbladder wall thickness, fasting gallbladder volumes and PGV were significantly higher in patients with NAFLD than control subjects (P < 0.001, P = 0.006, and P < 0.001, respectively). Gallbladder ejection fraction was significantly lower in the NAFLD group than the controls (P = 0.008). The presence of NAFLD was an independent predictor for GEF, PGV, and FGWT. Also, steatosis grade was an independent predictor for GEF, and GEF was significantly lower in the nonalcoholic steatohepatitis (NASH) subgroup than the controls. CONCLUSIONS: Gallbladder dysfunction and increase in gallbladder wall thickness exists in asymptomatic (without stone/sludge and related symptoms) patients with NAFLD and are useful in identifying fatty GD. Measurement of these variables in NAFLD patients may be useful in identifying those at higher risk for GD.

Effect of intended fasting on serum leptin, adiponectin and ghrelin levels

Physiology of gastrointestinal system including its hormones is in strong interaction with the brain. During Ramadan, "intention" to fast may act on this physiology. We aimed to find out if there was a difference between the effects of Ramadan fasting and non-Ramadan fasting on serum levels of some gastrointestinal hormones i.e.; leptin, adiponectin and ghrelin. Forty two healthy subjects were included in the study. Blood samples were obtained in the morning in two different days. The first day was during the last week of the Ramadan when they were fasting, and the second day was during the first week after the Ramadan with the same duration of fasting. The comparison of the leptin, adiponectin and ghrelin levels in this two measurements did not reveal any statistically significant differences [12.25 vs.11.56 ng/ml, 485.19 vs. 286.52 pg/ml, and 15.18 vs. 24.07 ng/ml; p=0.317, p=0.282, p=0.604 respectively]. Although it was not statistically significant, approximately fifty percent higher adiponectin and fifty percent lower ghrelin levels with Ramadan fasting suggests that there could be a different fasting physiology with intended fasting during Ramadan, which needs to be further investigated.

Are all fixed dose combinations equally effective in blood pressure control? the analysis of four different fixed dose antihypertensive combinations

Hypertension guidelines recommend the use of fixed dose combinations as the first step treatment in patients with stage 2 and 3 hypertension. The aim of this study was to compare the antihypertensive effects of four different fixed-dose preparations containing beta blocker [BB]-diuretic, ACE inhibitor [ACEI]-diuretic, angiotensin receptor blocker [ARB]-diuretic, and calcium channel blocker [CCB]-ACEI. Eighty patients with newly diagnosed hypertension whose sitting blood pressure [BP] >/= 160/100 mmHg were randomized to receive either of those four fixed dose antihypertensive preparations: atenolol 50 mg-hydrochlorotiazide [HCTZ] 12.5 mg, or lisinopril 20 mg-HCTZ 12.5 mg, or telmisartan 80 mg-HCTZ 12.5 mg or verapamil 180 mg- trandolapril 2 mg. All the patients were followed up for six months. Both systolic BP [SBP] and diastolic BP [DBP] were reduced similarly in all groups [45.7/22.4 mmHg in BB-diuretic group, 45.8/18.1 mmHg in ACEI-diuretic group, 54.6/17.6 mmHg in ARB-diuretic group and 38.9/16 mmHg in ACEI-CCB group. For SBP p=0.19 and for DBP p=0.43]. All investigated fixed dose antihypertensive combinations were found similarly effective in reducing blood pressure