Gallbladder wall inflammatory cells in pediatric patients with biliary dyskinesia and cholelithiasis: a pilot study Brian Rau a , Craig A. Friesen b, * , James F. Daniel b , Adnan Qadeer b , Ding You-Li b , Charles C. Roberts b , George W. Holcomb III c a University of Missouri—Kansas City, Kansas City, MO, USA b Division of Pediatric Gastroenterology, The Children’s Mercy Hospital and Clinics, Kansas City, MO 64108, USA c Department of Surgery, The Children’s Mercy Hospital and Clinics, Kansas City, MO 64108, USA Abstract Background/Purpose: Inflammation has been implicated in functional gastrointestinal disorders, including functional dyspepsia and irritable bowel syndrome. This study was undertaken to evaluate gallbladder wall inflammatory cells in children with abdominal pain related to gallstones and biliary dyskinesia to determine the candidate cell types that may be contributing to the pathophysiology of these entities. Methods: Gallbladder specimens from 20 patients with cholelithiasis, 20 biliary patients with dyskinesia, and 12 autopsy controls were evaluated in a blinded fashion. Eosinophil, tryptase-positive, and CD3+ cell densities were determined for the lamina propria and muscularis mucosa layers and compared between groups. Results: Patients with biliary dyskinesia and cholelithiasis had a 9- to 12-fold increase in mean and peak mast cell densities, respectively, in both layers as compared with controls. Peak (13.7 vs 8.4) and mean (9.2 vs 5.2) CD3+ cell densities were increased in the muscularis mucosae of cholelithiasis specimens as compared with biliary dyskinesia specimens. Conclusion: Gallbladder wall inflammatory cell densities, particularly mast cells, differ between children with cholelithiasis, children with biliary dyskinesia, and controls. Future studies are warranted to define the roles for specific inflammatory cell types. D 2006 Elsevier Inc. All rights reserved. The frequency of cholecystectomies is increasing in children [1]. The explanation is multifactorial. In part, this increase is owing to an increased diagnosis of gallstones and an increased recognition of biliary dyskinesia and chronic acalculous cholecystitis as causes of recurrent abdominal pain [1-4]. Also, laparoscopic cholecystectomy appears to be a safe and effective operation in properly selected children, particularly if performed before the development of complications [1,5]. The Rome II working group defined a number of functional gastrointestinal diseases in adults and children [6,7]. The adult diagnoses include biliary dysfunction defined by a clinical history of right upper quadrant or epigastric pain worsened by eating with pain-free intervals in conjunction with radiologic evidence of delayed gall- bladder emptying [6]. The pediatric diagnoses do not 0022-3468/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2006.05.015 * Corresponding author. Tel.: +1 816 234 3016; fax: +1 816 855 1721. E-mail address: cfriesen@cmh.edu (C.A. Friesen). Index words: Biliary dyskinesia; Cholelithiasis; Mast cells Journal of Pediatric Surgery (2006) 41, 1545 – 1548 www.elsevier.com/locate/jpedsurg