Cisapride improves gallbladder emptying and bile lipid composition in patients with gallstones

Background and Aim: Biliary cholesterol supersaturation, gallbladder stasis and delayed intestinal transit are the key events in cholesterol gallstone formation. We studied the effect of cisapride, a prokinetic drug, on gallbladder emptying and bile composition in patients with gallstone disease undergoing cholecystectomy. Methods: Gallbladder emptying, cholesterol saturation index (CSI) and nucleation time were studied in 21 patients with gallstone disease. Eleven patients (cisapride group, age 41.9 ± 2.9 years) received tablet cisapride 10 mg t.i.d. for 2 weeks, while 10 patients (placebo group, age 42.1 ± 1.9 years) received placebo for the same duration. Gallbladder emptying was repeated in all patients after a 2-week treatment with cisapride or placebo. Gallbladder bile was obtained at the time of surgery for the measurement of CSI and nucleation time. Results: Residual volume of the gallbladder decreased (mean ± SE, 18.6 ± 2.5 mL vs 10.0 ± 1.1 mL, P = 0.007), and the ejection fraction increased (43.5 ± 5.3% vs 60.0 ± 3.2%, P = 0.007) in patients in the cisapride group, while no change was observed in placebo group patients. Nucleation time was higher in the cisapride group than in the placebo group (14.9 ± 1.3 days vs 8.0 ± 0.9 days, P = 0.003). Patients in the cisapride group had a significantly lower cholesterol concentration (molar percentage, 5.1 ± 0.3% vs 6.8 ± 0.8%, P = 0.049) and CSI (1.0 ± 0.1 vs 1.36 ± 0.11, P = 0.034) than patients in the placebo group. Conclusion: Cisapride improves gallbladder emptying and bile lithogenicity in patients with gallstone disease.