Effect ofpredigested fat on intestinal stimulation ofplasma cholecystokinin andgall bladder motility incoeliacdisease

Cholecystokinin (CCK)release andgall bladder emptying inresponse toa fatty mealarecompletely abolished incoeliac disease. To determine theeffect oflipid digestion onCCK release andgallbladder motility, sixpatients withuntreated coeliac disease andaflat jejunal mucosa werestudied ontwoseparate days.After anovernight fast, theplasmaCCK concentration andgallbladder volumewere measured before andatregular intervals after theintraduodenal instillation of60 mlcornoil(triglycerides) incubated with 40mlsaline orwith40mlbileandpancreatic juice. Themean(SEM)concentrationoffreefattyacidsintheaqueous phaseofcornoilafter incubation withbile andpancreatic juice(predigested corn oil) was78(35)mM compared with0.1 (0. 1)mM intheaqueousphaseofcornoil incubated withsaline(undigested corn oil). Integrated plasmaCCK inresponse topredigested cornoilwassignificantly greaterthanthatin responseto undigested cornoil(101(18) pM.80minv-2 (9)pM.80min;p<0.005). Similarly, integrated gallbladdercontraction in response topredigested cornoilwassignificantly largerthanthatafterundigested cornoil(817(210) ml.80minv -225(243) ml.80min;p<0.05). Incontrasttoundigested cornoil, cornoilthat hasbeenpredigested withbileandpancreatic juice induces plasmaCCK secretionand gallbladdercontraction in patients withuntreated coeliac disease, presumably bygenerating andrendering soluble lipolytic products. (Gut 1995; 36:17-21)