Virginia Research Day 2021

Medical Resident Research Cl inical

08 Manual Drainage of the Gallbladder

Angelica Perry DO; Albert J Kozar DO, FAOASM, R-MSK Corresponding author: aperry@vt.vcom.edu

Introduction: Although osteopathic manipulative techniques (OMT) are often applied to the viscera, there is little research showing the effects that these techniques may have. Manual drainage of the gallbladder has long been practiced by osteopathic physicians. McConnel and Teall detail the palpation of a diseased gallbladder in The Practice of Osteopathy. Barral and Mercier describe manipulation of the common bile duct and emptying of the gallbladder in Visceral Manipulation, including the sound created when bile is discharged from the gallbladder. In Foundations for Osteopathic Medicine, Lossing states that the gallbladder should be evaluated and goes on to provide treatment strategies for both the gallbladder and the sphincter of Oddi. Current mainstream medical options for treatment of gallbladder dysfunction are limited to low-fat diet, expensive medication and invasive surgical techniques. Our primary aim is to demonstrate that OMT, applied with a whole body osteopathic approach in subjects with or without subclinical gallbladder disease, can cause the immediate ejection of the amount of bile that is equivalent to the established amount of bile ejected after eating a fatty meal (~30%). Edward Via College of Osteopathic Medicine-Virginia Campus VCOM Sports and Osteopathic Medicine

Methods: A cohort of patients who have not been diagnosed with or treated for gallbladder disease, but who have risk factors for gallbladder dysfunction, will be identified by an electronic medical record query of a busy, single, outpatient, multidisciplinary musculoskeletal medicine clinic (VSOM) based on age, gender and BMI. Participants will have their gallbladder volume calculated from ultrasound measurements then receive OMT. After OMT, the gallbladder will once again be imaged with ultrasound. Gallbladder ejection fraction (EF) will be calculated using the pre and post-treatment volumes. The OMT protocol will include osteopathic gallbladder drainage techniques, evaluation and treatment of spinal segments which provide neurological supply to the gallbladder, techniques to balance autonomic tone and treatment of the areas of greatest restriction, as assessed by the osteopathic examiner. Surveys will be completed before and after treatment and response to treatment among those who self- report symptoms of gallbladder dysfunction will be compared with response to treatment among those who self- report no symptoms. Subjects will be contacted for a short phone interview at 1 and 4 weeks after their appointment. This pilot study will include 10-20 patients.

Results : Data will be collected and analyzed in January 2021. Conclusions: Osteopathic philosophy teaches to approach a patient with any disease as a whole, unique unit of body, mind and spirit that has the capacity to heal. Manual therapy may provide a therapeutic option for treatment and prevention of gallbladder dysfunction with lower cost and lower risk compared to pharmaceuticals and surgical procedures. OMT is well tolerated by patients and may reduce both symptoms of gallbladder disease and the need for surgical intervention. Future study would include more subjects and add randomization to reduce bias.

This study was funded in part by the VCOM One Health Seed Grant

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