Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan.
National Research Center for Maternal and Child Health, Clinical Academic Department of Pediatrics, University Medical Center, Nur-Sultan 010000, Kazakhstan.
Nutrients. 2022 Oct 19;14(20):4379. doi: 10.3390/nu14204379.
: Celiac Disease (CD) is an immune-mediated disorder which primarily affects the small intestine; however, extra-intestinal organs are often affected by the pathological process, too. As regards the digestive system, liver alterations in CD patients have been widely described, which can also extend to the biliary tract. Notably, gallbladder function can be altered in CD patients. In this review, we specifically analyze and summarize the main pathophysiological aspects and clinical evidence of gallbladder dysfunction in CD patients, in order to discuss the potential medical complications and clinical research gaps. In addition to some perturbations of bile composition, CD patients can develop gallbladder dysmotility, which mainly expresses with an impaired emptying during the digestive phase. The main pathophysiological determinant is a perturbation of cholecystokinin secretion by the specific duodenal enteroendocrine cells in response to the appropriate nutrient stimulation in CD patients. This situation appears to be reversible with a gluten-free diet in most cases. Despite this gallbladder impairment, CD patients do not seem to be more predisposed to gallbladder complications, such as calculous and acalculous cholecystitis. However, very few clinical studies have actively investigated these clinical aspects, which may not be completely evidenced so far; alternatively, the substantial improvements in the last two decades regarding CD diagnosis, which have reduced the diagnostic delay (and related dietary treatment), may have lessened the potential clinical consequences of CD-related gallbladder dysfunction. Specific clinical studies focused on these aspects are needed for a better understanding of the clinical implications of gallbladder alterations in CD patients.
: 乳糜泻（CD）是一种免疫介导的疾病，主要影响小肠；然而，肠道外器官也常受到病理过程的影响。就消化系统而言，CD 患者的肝脏改变已被广泛描述，这些改变也可能扩展到胆道。值得注意的是，CD 患者的胆囊功能可能会发生改变。在这篇综述中，我们专门分析和总结了 CD 患者胆囊功能障碍的主要病理生理方面和临床证据，以讨论潜在的医学并发症和临床研究空白。除了胆汁成分的一些波动外，CD 患者还可能出现胆囊运动障碍，主要表现为在消化阶段排空功能受损。主要的病理生理决定因素是 CD 患者对适当营养刺激的特定十二指肠肠内分泌细胞分泌胆囊收缩素的紊乱。在大多数情况下，这种情况似乎可以通过无麸质饮食来逆转。尽管存在这种胆囊损伤，但 CD 患者似乎并没有更容易发生胆囊并发症，如结石性和非结石性胆囊炎。然而，很少有临床研究积极调查这些临床方面，这些方面到目前为止可能还没有完全得到证实；或者，在过去二十年中，CD 诊断的实质性改进减少了诊断延迟（和相关的饮食治疗），从而减轻了 CD 相关胆囊功能障碍的潜在临床后果。需要针对这些方面进行具体的临床研究，以更好地了解 CD 患者胆囊改变的临床意义。
