Histopathological changes in gallbladder mucosa in cholelithiasis: correlation with chemical composition of gallstones.

BACKGROUND: Cholelithiasis produces diverse histopathological changes in gallbladder mucosa namely acute inflammation, chronic inflammation, glandular hyperplasia, granulomatous inflammation, cholesterosis, dysplasia, and carcinoma. Gallstones have different chemical composition. They may be cholesterol, pigment or mixed stones. The aim of this prospective study was to see if any correlation existed between the chemistry of gallstones and any particular histopathologic picture. METHODS: Between May 1997 and December 1997 we diagnosed and operated on 40 patients with cholelithiasis. Diagnosis was established by ultrasound. After operation gallstones were sent for chemical analysis to detect presence of calcium bilirubinate and cholesterol. Serial sections of gallbladder from fundus to neck were stained by haematoxylin and eosin, and studied. RESULTS: Out of 40 patients (n = 40) 29 were females and 11 were males. The mean age of our patients was 38 +/- 21 years with a median of 40 years. Median age of males was 48 years compared to 38 years for females. Twenty-eight patients had mixed stones, 8 had pigment stones and 4 had cholesterol stones. Out of 28 patients with mixed stones 14 had histological picture of chronic cholecystitis, 8 had granulomatous cholecystitis, 4 had adenomatous hyperplasia, 1 had dysplasia and 1 had carcinoma. All 8 patients having pigment gallstones had chronic cholecystitis. Out of 4 patients with cholesterol gallstones, 2 had chronic cholecystitis, 1 had adenomatous hyperplasia and 1 had cholesterosis. Gallbladder having pigment stones were devoid of Rokitansky-Aschoff sinuses. CONCLUSION: Adenomatous hyperplasia and Rokitansky-Aschoff sinuses were not seen in gallbladder containing pigment stones but seen in gallbladders containing mixed and cholesterol stones in our study. Cholesterol may be a more potent stimulus for glandular hyperplasia or glandular hyperplasia may responsible for formation of cholesterol rich stones.

Gastroduodenal mucosa in peptic ulcer: endoscopic and histological assessment.

This study aimed to assess the prevalence of endoscopic and histological gastroduodenitis as well as helicobacter-like organisms in patients with peptic ulcer. After diagnostic endoscopy, gastroduodenal biopsy specimens were taken from thirty patients (n = 30) with clinical and endoscopic diagnosis of peptic ulcer (duodenal ulcer = 25, gastric ulcer = 5). Endoscopic gastroduodenitis occurred in 18 patients (60%). Histological gastritis was detected in the gastric body or antrum in 25 (83%) and duodenitis in 17 (57%) patients. There was significant correlation between endoscopic and histological gastritis (p < 0.05). Helicobacter-like organisms occurred in 73% of the patients with peptic ulcer and in 88% of the antral biopsy specimens showing antral gastritis. Presence of helicobacter-like organisms was in particular associated with acute on chronic gastritis compared to chronic gastritis (p < 0.01). Moreover the patients with gastritis were found to belong to the older age group and 81.8% had blood group O +ve (p < 0.01 and p < 0.05 respectively). We conclude that presence of helicobacter-like organisms in patients with peptic ulcer is significantly associated with acute on chronic gastritis.