AIM:Gallbladder and gastrointestinal motility defects existin gallstones patients and to a lesser extent in pigmentgallstone patients.To investigated the role of gallbladderand gastrointestinal motility disorders in pigment gallstoneformation in β-thalassemia major.METHODS:Twenty-three patients with β-thalassemiamajor (16 females;age range 18-37 years) and 70 controls(47 females,age range 18-40 years) were studied forgallbladder and gastric emptying (functional ultrasonography),orocecal transit (OCTT,H_2-breath test),autonomicdysfunction (sweat-spot,cardiorespiratory reflex tests),bowel habits,gastrointestinal symptoms and quality of life(all with questionnaires).Gallbladder content (ultrasonography)was examined before and during 8-12 mo follow-up.RESULTS:Gallstones and/or biliary sludge were found in13 (56%) patients.β-thalassemia major patients hadincreased fasting (38.0±4.8mL vs20.3±0.7mL,P=0.0001)and residual (7.9±13mL vs5.1±0.3mL,P=0.002) volumeand slightly slower emptying (24.9±1.7min vs20.1±0.7min,P=0.04) of the gallbladder,together with longer OCTT(132.2±7.8 min vs99.7±2.3 min,P=0.00003) than controls.No differences in gastric emptying and bowel habits werefound.Also,patients had higher dyspepsia (score:6.7±1.2vs 4.9+0.2,P=0.027),greater appetite (P=0.000004)and lower health perception (P=0.00002) than controls.Autonomic dysfunction was diagnosed in 52% of patients(positive tests:76.2% and 66.7% for parasympathetic andsympathetic involvement,respectively).Patients developingsludge during follow-up (38%,2 with prior stones) hadincreased fasting and residual gallbladder volume.CONCLUSION:Adult β-thalassemia major patients havegallbladder dysmotility associated with delayed smallintestinal transit and autonomic dysfunction.These abnormalities apparently contribute together with haemolytichyperbilirubinemia to the pathogenesis of pigment gallstones/sludge in β-thalassemia major. AIM: Gallbladder and gastrointestinal motility defects exist in gallstone patients and to a lesser extent in pigmentgallstone patients. To investigated the role of gallbladder and gastrointestinal motility disorders in pigment gallstoneformation in beta-thalassemia major. METHODS: Twenty-three patients with beta-thalassemia major (16 females ; age range 18-37 years) and 70 controls (47 females, age range 18-40 years) were studied for gallbladder and gastric emptying (functional ultrasonography), orocecal transit (OCTT, H2- breath test), autonomicdysfunction (sweat- Cardiorespiratory reflex tests), bowel habits, gastrointestinal symptoms and quality of life (all with questionnaires) .Gallbladder content (ultrasonography) was examined before and during 8-12 mo follow-up .RESULTS: Gallstones and / or biliary sludge were found in13 ( 56%) patients.β-thalassemia major patients had increased fasting (38.0 ± 4.8 mL vs 20.3 ± 0.7 mL, P = 0.0001) and residual (7.9 ± 13 mL vs 5.1 ± 0.3 mL, P = 0.002) volume and slightly slower emptying (24.9 ± 1.7 min vs 20.1 ± 0.7 min, P = 0.04) of the gallbladder, together with longer OCTT (132.2 ± 7.8 min vs 99.7 ± 2.3 min, P = 0.00003) than controls. No differences in gastric emptying and bowel habits were found. Also, patients had higher dyspepsia (score: 6.7 ± 1.2 vs 4.9 + 0.2, P = 0.027), greater appetite (P = 0.000004) and lower health perception (P = 0.00002) than controls. Autonomic dysfunction was diagnosed in 52 % of patients (positive tests: 76.2% and 66.7% for parasympathetic and sympathetic involvement, respectively). Patients developingsludge during follow-up (38%, 2 with prior stones) hadincreased fasting and residual gallbladder volume. CONCLUSION: Adult β-thalassemia major patients havegallbladder dysmotility associated with delayed small intestinal transit and autonomic dysfunction. These abnormalities apparently contribute together with haemolytichyperbilirubinemia to the pathogenesis of pigment gallstones / sludge in beta-thalassemia major.