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Open Access Research article

Mast cell activation and clinical outcome in pediatric cholelithiasis and biliary dyskinesia

Craig A Friesen1*, Nancy Neilan1, James F Daniel1, Kim Radford1, Jennifer V Schurman1, Ding-You Li1, Linda Andre1, Shawn D St Peter2 and George W Holcomb2

Author Affiliations

1 Department of Pediatrics, The Children's Mercy Hospital, 2401 Gillham Rd., Kansas City, Missouri, USA

2 Department of Surgery, The Children's Mercy Hospital, 2401 Gillham Rd., Kansas City, Missouri, USA

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BMC Research Notes 2011, 4:322  doi:10.1186/1756-0500-4-322

Published: 6 September 2011

Abstract

Background

The current study was undertaken to determine the degree of activation of gallbladder mucosal mast cells, whether mast cell (MC) density or activation differ between patients with and without a positive clinical response to cholecystectomy, and whether either density or activation correlate with gallbladder emptying.

Results

Fifteen biliary dyskinesia (BD) and 13 symptomatic cholelithiasis (CL) patients undergoing cholecystectomy were prospectively enrolled. Gallbladder wall MC density (by immunohistochemistry) and activation (by electron microscopy) were determined. Clinical response was evaluated 30 days post-cholecystectomy on a 5-point Likert-type scale. A complete or nearly complete clinical response was seen in 100% of CL and in 87% of BD patients. The overall degranulation indices were 49.4 ± 18.7% for CL patients and 44.2 ± 16.8% for BD patients. Neither MC density nor activation correlated with the gallbladder ejection fraction. A complete clinical response was associated with lower epithelial MC density.

Conclusion

Cholecystectomy is efficacious in relieving pain in both CL and BD patients. BD and CL are associated not only with increased MC density but a moderate to high degree of MC activation. A possible relationship between MC density and outcome for BD warrants further investigation.

Keywords:
mast cell; biliary dyskinesia; cholelithiasis; cholecystectomy