To investigate the mechanisms controlling human gallbladder contraction, especially to determine the role of neural factors, the gallbladder response to various stimuli was evaluated in eight normal subjects using realtime ultrasonography. In addition, plasma cholecystokinin (CCK) levels were measured using a region-specific antibody (OAL 656). Intramuscular injections of CCK-8 and of cerulein induced mean maximal ejection fractions (EF max) of 50% +/- 6% and 58% +/- 4%, respectively. The mean EF max after ingestion of a fatty meal was 44% +/- 3%, while the EF max after a fat-restricted meal was significantly lower (17% +/- 4%). Oral water and sham feeding also significantly induced gallbladder contractions (EF max; 25% +/- 4% and 12% +/- 4% respectively) that were eliminated by premedication with atropine. The plasma CCK rose significantly after exogenous administration of CCK-8 and after ingestion of a fatty meal. The peak CCK concentration released after fatty meals was almost identical to that after exogenous CCK-8 loading. In contrast, plasma CCK levels showed no change after the fat-restricted meal, oral water and sham feeding. These findings suggest that not only CCK but also the cholinergic pathway may play important roles in the control mechanism of human gallbladder contraction.