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ABSTRACT Background: Common bile duct (CBD) stones are known to complicate 10-15% of gallstone diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is the therapeutic modality of choice for bile duct clearance in CBD stones but may fail to achieve stone clearance. This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. Objective: This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. Methods: All consecutive patients with bile duct stones undergoing ERCP at a tertiary care center were prospectively included from October 2020 to October 2021. The study's primary outcome was to identify and analyze factors that could predict the failure of complete CBD clearance. Results: A total of 120 patients (50.8% males, median age: 53.5 years) were included in the final analysis. Successful clearance of CBD stones during the index procedure was achieved in 70% of patients. At a cut-off stone diameter of >10.5 mm and CBD diameter of >12.5 mm, the AUC was 0.890 and 0.884, respectively, to predict failed clearance of CBD. On multivariate analysis, stone diameter ≥15 mm [odds ratio (OR) 16.97, 95% confidence interval (CI): 1.629-176.785], location of stones in hepatic ducts (OR 7.74, 95%CI: 2.041-29.332), presence of stricture distal to stone (OR 6.99, 95%CI: 1.402-34.726) and impacted stone (OR 21.61, 95%CI: 1.84-253.058) were independent predictors of failed bile duct clearance. Conclusion: Stone size and location are independent predictors of failed bile duct clearance. The endoscopist should consider these factors while subjecting a patient to biliary ductal clearance to plan additional intervention.
RESUMO Contexto: Cálculos do ducto biliar comum (CDC) são conhecidos por complicar 10-15% das doenças de cálculos biliares. A colangiopancreatografia retrógrada endoscópica (CPRE) é a modalidade terapêutica de escolha para a limpeza do CDC, mas pode falhar na sua remoção. Objetivo: Este estudo prospectivo foi realizado para identificar os previsores de falha na limpeza do CDC com CPRE. Métodos: Pacientes consecutivos com cálculos no ducto biliar submetidos a CPRE em um centro de atendimento terciário foram incluídos prospectivamente de outubro de 2020 a outubro de 2021. O principal resultado do estudo foi identificar e analisar fatores que poderiam prever a falha na limpeza completa do CDC. Resultados: Um total de 120 pacientes (50,8% homens, idade média: 53,5 anos) foram incluídos na análise final. A limpeza bem-sucedida dos cálculos de CDC durante o procedimento inicial foi alcançada em 70% dos pacientes. Com um diâmetro de corte de cálculos >10,5 mm e de diâmetro de CDC de >12,5 mm, a AUC foi de 0,890 e 0,884, respectivamente, para prever a falha na limpeza do CDC. Na análise multivariada, diâmetro da cálculos ≥15 mm [razão de chances (OR) 16,97, intervalo de confiança de 95% (IC): 1,629-176,785], localização dos cálculos nos ductos hepáticos (OR 7,74, IC95%: 2,041-29,332), presença de estreitamento distal ao cálculo (OR 6,99, IC95%: 1,402-34,726) e cálculo impactado (OR 21,61, IC95%: 1,84-253,058) foram previsores independentes de falha na limpeza do ducto biliar. Conclusão: O tamanho e a localização dos cálculos são previsores independentes de falha na limpeza do ducto biliar. O endoscopista deve considerar esses fatores ao submeter um paciente à limpeza ductal biliar para planejar intervenção adicional.
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Background: The prevalence of gallstones among different populations is varied, which reflects the role of genetic and environmental factors, besides common factors like age, sex, parity, obesity and diet. Being a commonly treated surgical problem, we attempted to study the epidemiology, risk factors and predisposing factors related to gallbladder disease in our setup- the industrial township of Bharat Heavy Electricals Limited (BHEL), Bhopal, India.Methods: This was an observational study done over a period of 2 years. The patients were analyzed on the basis of age and sex distribution, dietary habits, body mass index, activity level, monthly income, family history, parity, associated illness if any, and abdominal ultrasound findings.Results: Of 104 patients, 44 were males and 60 females, with female to male ratio being 1.36:1. The commonest age group to be affected was 61 to 70 years (35 patients, 33.65%). Better socioeconomic status, lower activity level, higher parity, vegetarian diet and consumption of plant-origin fats were the factors present in most patients. No family history was present in 97.11% patients.Conclusions: As gallstones have multi-factorial etiology, it is difficult to disassociate their influence and to pin point towards the contribution of any one factor. But the results suggest that there is more than what meets the eye. Higher incidence in males and absence of family history point towards a cause not found in genes or at home, but something present in the workplace environment, where men form the major part of workforce.
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Background: Gallstone disease (GSD) is a common gastrointestinal disease diagnosed in patients presented with abdominal pain. The present study was aimed to find the association between demographic, personal, behavioural and dietary factors and GSD by gender among adult population for suggesting specific gender wise intervention to control GSD.Methods: Case-control study was conducted in 120 cases and same number of controls. Data was collected on a self-designed pretested “interview schedule”. To measure the strength of association OR was calculated by matched pair analysis using McNemar’s test.Results: Among 120 study subjects, 83 cases were females and 37 were males. Strength of association was found to be significantly higher for family h/o GSD in females (OR=8), physical inactivity (OR=8), waist-hip ratio (OR=4.2), calorie intake more than recommended dietary allowance (RDA) (OR=2.09), and diabetes (OR=4) as compare to males OR=3, OR=2.8, OR=2.5, OR=1.43, OR=2.33 respectively.Conclusions: Family h/o GSD, physical inactivity, high waist-hip ratio, calorie and fat intake more than RDA, protein intake less than RDA, hypertension and diabetes were found to be potential risk factors for the development of GSD in females. Consumption of smokeless tobacco, physical inactivity, non-vegetarian diet and intake of fats more than RDA were risk factors for GSD in males.
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BACKGROUND/AIMS: Gallstone disease (GSD) is a common gastrointestinal disorder. Clinical epidemiological studies revealed that alcohol consumption has a preventive effect on the development of GSD. This study aimed to evaluate the relative risks of drinking for GSD development and investigate the dose-response relationships. METHODS: A systematic search of the MEDLINE, EMBASE, and Cochrane Library databases for studies published up to 2018 was performed. All studies that satisfied the following eligibility criteria were included: patients with GSD with or without cholecystitis; and cohort or case-control studies investigating the association between alcohol consumption and GSD development. RESULTS: Sixteen case-control studies including 24,401 gallstone cases and 76,185 controls, and eight cohort studies with 14,693 GSD cases among 2,432,471 person-years were enrolled. Alcohol consumption presented a decreased overall risk of GSD (pooled relative ratio [RR], 0.84; 95% confidence interval [CI], 0.79 to 0.89; p=0.02). Subgroup analyses according to drinking levels indicated a gradual risk reduction for GSD compared to nondrinkers (light: RR, 0.96; 95% CI, 0.94 to 0.99; p=0.75; moderate: RR, 0.80; 95% CI, 0.75 to 0.85; p=0.27; high: RR, 0.66; 95% CI, 0.56 to 0.79; p < 0.01). A nonlinear risk reduction was observed in a dose-response meta-analysis of all the studies (n=14, p < 0.01 for nonlinearity). CONCLUSIONS: In this systematic review with meta-analysis, alcohol consumption could decrease the risk of GSD, and the dose-response analysis revealed a dose-dependent linear risk reduction and a weakened linear trend between alcohol consumption levels less than and greater than 28 g/day.
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Humans , Alcohol Drinking , Case-Control Studies , Cholecystitis , Cohort Studies , Drinking , Epidemiologic Studies , Gallstones , Risk Reduction BehaviorABSTRACT
Background: Gallstone disease is one of the most common abdominal conditions for which patients are admitted in surgical wards of hospitals. Aim & Objective: The study was conducted to understand the association between behavioral and personal factors and gall stone disease among study subjects. Settings & Design: a case-control study conducted in a tertiary care hospital of New Delhi. Material & Methods: 120 each of cases and controls of over 20 years, matched for age and sex were recruited in the study. Data collection was done on a self-designed pretested “interview schedule.” Statistical analysis: The observations have been described in terms of mean and standard deviation for continuous data. To measure the strength of association simple Odd’s Ratio (OR) was calculated and McNemar’s test was used for matched pair analysis. Binary logistic regression was used for multivariate analysis to find out different correlates and analyses the independent effects of these correlates on GSD. Results: weight (59.20±9.57), height (159.67±6.25), BMI (23.20±3.15), waist circumference (75.79±7.07) and W/H ratio (0.80±0.06) were significantly higher [as seen by applying student t test] in cases as compared to controls 54.84±7.02, 156.58±4.93, 21.95±2.81, 73.49±6.09 and 0.77±0.05 respectively. High parity [OR-5.75, 95% CI 1.99-16.63] had the strongest association followed by high W/H ratio [OR-5.25, 95% CI 1.80-15.29], sedentary physical activity [OR-4.75, 95% CI 2.22-10.18], smoking [OR-3.4, 95% CI 1.25-9.21], consumption of smokeless tobacco [OR-2.36, 95% CI 1.17-4.78] and high BMI [OR-1.71, 95% CI1.03-2.83]. Conclusion: High parity, High W/H ratio, Physical inactivity, Current smoking, Smokeless tobacco and high BMI were found to be risk factors for the development of gallstone disease.
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Recent studies have found that non-alcoholic fatty liver disease(NAFLD) has great impact on the development of biliary tract diseases. Here in this review, we summarized the relationship between NAFLD and the occurrence and development, risk factors and severity of cholestasis, gallstones, intrahepatic cholangiocarcinoma, primary biliary cirrhosis and bile microbiota, so as to further illuminate the pathogenesis of NAFLD and biliary tract diseases, obtain better diagnostic and therapeutic outcomes on NAFLD and biliary tract diseases.
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Background & objectives: Loss of function of adenomatous polyposis coli (APC) has been reported in cancer. The two promoters of APC, 1A and 1B also have roles in cancer. But, the epigenetic role of APC promoters is not yet clear in gallbladder cancer (GBC) and gallstone diseases (GSD). We undertook this study to determine the epigenetic role of APC in GBC and GSD. Methods: Methylation-specific (MS)-PCR was used to analyze the methylation of APC gene. The expression of APC gene was studied by semi-quantitative PCR, real-time PCR and immunohistochemistry (IHC) in GBC, GSD and adjacent normal tissues. Results: Of the two promoters, APC 1A promoter was found methylated in 96 per cent GBC (P=0.0155) and 80 per cent GSD (P=0.015). Exon 1 was downregulated in grade II (P=0.002) and grade III (P=0.0001) of GBC, while exon 2 was normally expressed. Scoring analysis of IHC revealed 0 or negativity in 34.48 per cent (P=0.057) and 1+ in 24.14 per cent (P=0.005) GBC cases suggesting loss of APC expression. Interpretation & conclusions: The present findings indicate epigenetic silencing of APC in advanced GBC. The methylation pattern, followed by expression analysis of APC may be suggested for diagnostic, prognostic and therapeutic purposes in GBC in future.
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Objective: To investigate the distribution of pathogens and drug resistance in bile and the association between the pregnane X receptor (PXR) gene polymorphisms, traditional Chinese medicine (TCM) syndromes and the risk of cholesterol gallstone disease (CGD). Methods: A total of 392 samples were enrolled in this study from January 2014 to February 2015, among which 192 patients were with CGD, and 200 samples were healthy. Strains were isolated and susceptibility testing was the disk diffusion method susceptibility testing. The patients were divided into hepatochlic hygropyrexia, stagnation of liver-qi, and the accumulation of damp. The PXR gene polymorphisms were analyzed by polymerase chain reaction-restriction fragment length polymorphism. The association between the PXR gene polymorphisms and the risk of CGD was examined by logistic regression analysis. Results: A total of 192 cases were detected in 230 of bile culture pathogens, including Gram-negative bacteria 133 (57.83%), Gram-positive bacteria 76 (33.04%), and fungi 21 (9.13%). The top five pathogens were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, Candida albicans, and Enterococcus feces, of which 110 cases was of single infection, 48 cases of mixed infection of two strains, eight cases of mixed infection of three bacteria. Among 59 Escherichia coli, the yield extended-spectrum beta-lactamases had 40 (67.80%). The hepatochlic hygropyrexia was the most TCM syndrome, followed by stagnation of liver-qi, and the accumulation of damp was least. Different pathogens and the rs6785049 genotypes distributed differently in cholelithiasis patients with different TCM syndromes (P < 0.05). In hepatochlic hygropyrexia patients the Gram-negative bacteria was most. There was significant differences between CGD group and control group in rs6785049 (P < 0.001). Comparison with wild-type portable GG, GA genotype increased the risk of the occurrence of gallstones (OR = 0.40, 95%CI: 0.16-0.79); likewise, carrying the GA+AA genotype also increased the risk (OR = 0.38, 95%CI: 0.19-0.81). There was no significant differences in rs2276707, rs3814055 site polymorphic loci alleles in CGD group and control group. Conclusions: In the treatment of cholelithiasis, bile samples should be collected for bacterial culture and sensitivity test, and drugs should be strictly chosen based on the results. The rs6785049 polymorphisms in PXR gene may increase the risk of gallstones ontogeny, and gallstones can be early detected and prevented by detecting genotypes. rs6785049 polymorphisms in PXR gene may has relationship with TCM syndromes.
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OBJECTIVE@#To investigate the distribution of pathogens and drug resistance in bile and the association between the pregnane X receptor (PXR) gene polymorphisms, traditional Chinese medicine (TCM) syndromes and the risk of cholesterol gallstone disease (CGD).@*METHODS@#A total of 392 samples were enrolled in this study from January 2014 to February 2015, among which 192 patients were with CGD, and 200 samples were healthy. Strains were isolated and susceptibility testing was the disk diffusion method susceptibility testing. The patients were divided into hepatochlic hygropyrexia, stagnation of liver-qi, and the accumulation of damp. The PXR gene polymorphisms were analyzed by polymerase chain reaction-restriction fragment length polymorphism. The association between the PXR gene polymorphisms and the risk of CGD was examined by logistic regression analysis.@*RESULTS@#A total of 192 cases were detected in 230 of bile culture pathogens, including Gram-negative bacteria 133 (57.83%), Gram-positive bacteria 76 (33.04%), and fungi 21 (9.13%). The top five pathogens were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, Candida albicans, and Enterococcus feces, of which 110 cases was of single infection, 48 cases of mixed infection of two strains, eight cases of mixed infection of three bacteria. Among 59 Escherichia coli, the yield extended-spectrum beta-lactamases had 40 (67.80%). The hepatochlic hygropyrexia was the most TCM syndrome, followed by stagnation of liver-qi, and the accumulation of damp was least. Different pathogens and the rs6785049 genotypes distributed differently in cholelithiasis patients with different TCM syndromes (P < 0.05). In hepatochlic hygropyrexia patients the Gram-negative bacteria was most. There was significant differences between CGD group and control group in rs6785049 (P < 0.001). Comparison with wild-type portable GG, GA genotype increased the risk of the occurrence of gallstones (OR = 0.40, 95%CI: 0.16-0.79); likewise, carrying the GA+AA genotype also increased the risk (OR = 0.38, 95%CI: 0.19-0.81). There was no significant differences in rs2276707, rs3814055 site polymorphic loci alleles in CGD group and control group.@*CONCLUSIONS@#In the treatment of cholelithiasis, bile samples should be collected for bacterial culture and sensitivity test, and drugs should be strictly chosen based on the results. The rs6785049 polymorphisms in PXR gene may increase the risk of gallstones ontogeny, and gallstones can be early detected and prevented by detecting genotypes. rs6785049 polymorphisms in PXR gene may has relationship with TCM syndromes.
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Introduction: The frequency of gallstone disease among pregnant women attending for antenatal care in Egypt progressively increased during the last few decades. This study aimed to investigate the possible risk factors of gallstone disease among pregnant women attending two obstetrics and gynecology centers in Egypt (Ain Shams Obstetrics and Gynecology University Hospital, Cairo, Egypt and Obstetrics and Gynecology department at Mansoura University Hospital). Methods: A Case control study was conducted, cases were (170) pregnant women with diagnosed gallstone disease and controls were age matched pregnant women without gallbladder disease (170). Both cases and controls were subjected to interview questionnaire. Nutrient intakes were calculated. Body mass index (BMI) was calculated. Ultrasound examination was performed. Blood samples were analyzed for lipid profile. Results: Socio-demographic risk factors were illiteracy (OR=14.3), insufficient income (OR=10.6), non working (OR=3) and low social score (OR=3). Reproductive risk factors were previous hormonal contraception (OR=7.9), family history of gall stones (OR=4.2) and parity ≥4 (OR=3.8). The risk of gall bladder stone disease increased by increase in BMI (OR=12.8 for BMI ≥ 30 kg/ m2). The highest risky nutritional behaviors respectively were; the preference of fried meals (OR=41.3), taking more than two food servings rich in animal fat per day (OR=38.9), the habit of eating eastern sweets ≥twice weekly (OR=18.7), food intake between meals (OR=14) and night eating (OR=8.7). The highest risky physical activity score was light physical activity (OR=4.1). Conclusion: Multiple risk factors were found among pregnant women with gallbladder disease. Most of them are modifiable.
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Objective To investigate the role and possible mechanism of caveolin-1 (CAV1) in the forming of cholesterol gallstone in mice fed with lithogenic diet.Methods Cholesterol gallstone susceptible C57BL/6 mice were study objects.The mice of control group (n=6) and experiment group (n=6) were fed with normal diet and lithogenic diet for four weeks respectively.The condition of cholesterol gallstone forming,changes of serum lipid and bile composition were measured,and the expressions of CAV1 and scavenger receptor classB member Ⅰ (SR-BⅠ) at mRNA and protein level in the liver and gallbladder were detected by realtime-polymerase chain reaction and Western blot,respectively.The t test was performed for mean comparsion between the two groups.Results The incidence rate of gallstone in experimental group was 100％ after fed with lithogenic diet for four weeks,the lipid level significantly increased,and the proportion of cholesterol in bile raised and bile salt decreased.Compared with those of control group,the expressions of CAV1 at mRNA and protein level in the liver and gallbladder tissues siginificantly decreased (in liver tissue,mRNA 0.53 ± 0.13 vs 1.00 ± 0.32,t =3.330,protein level 0.39 ± 0.07vs 0.92±0.06,t=10.280; in gallbladder tissue,mRNA 0.40±0.22 vs 1.00±0.22,t=3.823,protein level 1.04±0.07 vs 1.34 ± 0.04,t =6.367,all P＜0.01).There was no significant difference in the relative expression of SR-BⅠ at mRNA and protein level in the liver and gallbladder tissues between the mice of experiment group and control group.Conclusion The changes of CAV 1 expression at mRNA and protein level in liver and gallbladder tissues may affect lipids metabolism and cholesterol transportation in liver and gallbladder tissues of experiment mice,which might play an important role in the formation of cholesterol gallstone.
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Objective To investigate the association of metabolic syndrome and calculous chole-cystitis.Methods The retrospective cross-sectional study was conducted between July 2012 to February 2013.Seventy-two consecutive patients with calculous cholecystitis were included as study participants and 58 patients with asymptomatic gallstone were recruited as controls.Basic demographic data,waistline,blood sugar,blood fat,blood pressure,abdominal ultrasonography and other laboratory tests were collected.Re-sults The prevalence of metabolic syndrome in patients with symptomatic gallstone was significant higher than the controls(47.2% vs 22.4%,P<0.05).The presence of the metabolic syndrome(OR 1.452, 95%CI 1.210~1.694,P=0.018)and large gallstones(diameter≥2.5 cm,OR 1.138,95%CI 1.028 ~1.248)were significantly correlated with symptomatic gallstone.Conclusion The presence of metabolic syndrome may increase asymptomatic gallstone patients'risk of developing symptomatic calculous cholecys-titis.
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BACKGROUND/AIMS: We sought to examine whether the presence of gallstone disease (GD) in patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD) is associated with liver fibrosis and histological nonalcoholic steatohepatitis (NASH) score. METHODS: We included 441 Turkish patients with biopsy-proven NAFLD. GD was diagnosed in the presence of sonographic evidence of gallstones, echogenic material within the gallbladder with constant shadowing and little or no visualization of the gallbladder or absence of gallbladder at ultrasonography, coupled with a history of cholecystectomy. RESULTS: Fifty-four patients (12.2%) had GD (GD+ subjects). Compared with the GD- subjects, GD+ patients were older, had a higher body mass index and were more likely to be female and have metabolic syndrome. However, GD+ patients did not have a higher risk of advanced fibrosis or definite NASH on histology. After adjustment for potential confounding variables, the prevalence of GD in NAFLD patients was not associated with significant fibrosis (> or =2) (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.53 to 2.21; p=0.68) or definite NASH (OR, 1.03; 95% CI, 0.495 to 2.12; p=0.84). CONCLUSIONS: The presence of GD is not independently associated with advanced fibrosis and definite NASH in adult Turkish patients with biopsy-proven NAFLD.
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Female , Humans , Male , Middle Aged , Biopsy , Fatty Liver/pathology , Gallbladder/pathology , Gallstones/complications , Liver/pathology , Liver Cirrhosis/pathology , Non-alcoholic Fatty Liver Disease/complications , Prospective Studies , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Porcelain gallbladder is an uncommon manifestation of chronic cholecystitis. The wall of the gallbladder becomes hard, calcified and brittle with a bluish-white tinge which resembles a porcelain ceramic. This condition is associated with increased risk of malignancy. We report two cases, both female patients (both 56 years old) who were diagnosed with porcelain gallbladder. One presented with a pyogenic liver abscess and the other was diagnosed to have gallbladder carcinoma on the background of porcelain gallbladder with metastases in liver.
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Carcinoma , Cholecystitis , GallstonesABSTRACT
Since the discovery of the low-density lipoprotein receptor (LDLR) and its association with familial hypercholesterolemia in the early 1980s, a family of structurally related proteins has been discovered that has apolipoprotein E as a common ligand, and the broad functions of its members have been described. LRP2, or megalin, is a member of the LDLR family and was initially called gp330. Megalin is an endocytic receptor expressed on the apical surface of several epithelial cells that internalizes a variety of ligands including nutrients, hormones and their carrier proteins, signaling molecules, morphogens, and extracellular matrix proteins. Once internalized, these ligands are directed to the lysosomal degradation pathway or transported by transcytosis from one side of the cell to the opposite membrane. The availability of megalin at the cell surface is controlled by several regulatory mechanisms, including the phosphorylation of its cytoplasmic domain by GSK3, the proteolysis of the extracellular domain at the cell surface (shedding), the subsequent intramembrane proteolysis of the transmembrane domain by the gamma-secretase complex, and exosome secretion. Based on the important roles of its ligands and its tissue expression pattern, megalin has been recognized as an important component of many pathological conditions, including diabetic nephropathy, Lowe syndrome, Dent disease, Alzheimer's disease (AD) and gallstone disease. In addition, the expression of megalin and some of its ligands in the central and peripheral nervous system suggests a role for this receptor in neural regeneration processes. Despite its obvious importance, the regulation of megalin expression is poorly understood. In this review, we describe the functions of megalin and its association with certain pathological conditions as well as the current understanding of the mechanisms that underlie the control of megalin expression.
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Humans , Alzheimer Disease/metabolism , /physiology , Alzheimer Disease/physiopathology , Biological Transport/physiology , Cholesterol/physiology , Gallstones/metabolism , Gallstones/physiopathology , Gene Expression Regulation/physiology , Homeostasis/physiology , Kidney Diseases/metabolism , Kidney Diseases/physiopathology , /genetics , /metabolism , Tissue Distribution/physiologyABSTRACT
ObjectiveTo investigate the single nucleotide polymorphisms (SNPS) in the coding regions of the human ABCA2 gene and to determine the association of some of these SNPs with gallstone disease in a Chinese population. MethodsThe exons and part of the introns of the ABCA2 gene were sequenced using a fluorescent labeling automatic method in 24 patients with gallstone disease to identify and characterize the SNPs in a Chinese population. For SNPs in the exons, case-control studies were performed on patients and controls. ResultsTwelve SNPs were found within a 16911 bp region of the ABCA2 gene. Among them, two were in the exons, ten in the introns and five were novel SNPs. There was no significant difference in the SNPs genotype between the patients and the controis. ConclusionsThere is an important ethnic difference in the SNPs distribution of the human ABCA2 gene. The distribution of SNPs in the coding regions of the human ABCA2 gene is not significantly different between the patients and the controls.
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BACKGROUND/AIMS: Bacterial infection is accepted as a precipitating factor in cholesterol gallstone formation, and recent studies have revealed the presence of Helicobacter species in the hepatobiliary system. We utilized the polymerase chain reaction (PCR) to establish the presence of bacterial DNA, including from Helicobacter species, in gallstones, bile juice, and gallbladder mucosa from patients with gallstones. METHODS: At cholecystectomy, 58 gallstones, 48 bile samples, and 46 gallbladder mucosa specimens were obtained and subjected to nested PCR using specific 16S rRNA primers of H. pylori and other bacteria. Bacterial species were identified by DNA sequencing analysis. Bacterial 16S rRNA was detected in 25 out of 36 mixed-cholesterol gallstones, 1 out of 10 pure-cholesterol gallstones, and 9 out of 12 pigmented stones. Furthermore, 16S rDNA sequencing identified Escherichia coli, Pseudomonas, Citrobacter, Klebsiella, and Helicobacter species. RESULTS: Helicobacter DNA was detected in 4 out of 58 gallstones, 6 out of 48 bile samples, and 5 out of 46 gallbladder specimens. Direct sequencing of Helicobacter amplicons confirmed strains of H. pylori in all four gallstones, five out of six bile samples, and three out of five gallbladder specimens. Almost all mixed-cholesterol gallstones appear to harbor bacterial DNA, predominantly E. coli. CONCLUSIONS: H. pylori was also found in the biliary system, suggesting that these bacteria are of etiological importance in gallstone formation.
Subject(s)
Humans , Bacteria , Bacterial Infections , Bile , Biliary Tract , Cholecystectomy , Cholecystitis , Cholesterol , Citrobacter , DNA , DNA, Bacterial , DNA, Ribosomal , Escherichia coli , Gallbladder , Gallstones , Helicobacter , Helicobacter pylori , Klebsiella , Mucous Membrane , Polymerase Chain Reaction , Precipitating Factors , Pseudomonas , Sequence Analysis, DNAABSTRACT
BACKGROUND/AIMS: To investigate the epidemiologic changing patterns of gallstone diseases in Korea during past 25 years. METHODS: A total of 5,671 gallstone patients who underwent surgery in our center during 1981-2005 were analyzed. The patients were divided into 5 periods: period I (1981-1985, n=831), period II (1986-1990, n=888), period III (1991-1995, n=1,040), period IV (1996-2000, n=1,261) and period V (2001-2005, n=1,651). Korean literatures published from 1961 to 2005 were reviewed to elucidate the nationwide trends of gallstone diseases. RESULTS: Number of gallstone disease cases were gradually increasing. Female predominance was not noted (male/female ratio, 1.07-1.37). Patients with common bile duct (CBD) stone were older than those with gallbladder (GB) stone or intrahepatic duct (IHD) stone. During past 25 years, relative proportion of GB stone cases increased from 53.0% to 89.7%, while that of CBD stone cases decreased from 68.0% to 15.1%. Relative proportion of IHD stone patients remained stationary. In rural areas, tendency of increasing GB stone and decreasing CBD stone disappeared since period III. However, in urban areas, these tendencies remained till period V. Relative frequency of IHD stone group remained unchanged in two areas. The body mass indexes of the GB stone group, CBD stone group, and IHD stone group were higher than that of the average population. CONCLUSIONS: In gallstone disease, increasing tendency of GB stone and decreasing tendency of CBD stone in rural area have disappeared. However, relative frequency of IHD stone is still high in Korea.
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Female , Humans , Male , Middle Aged , Body Mass Index , Demography , Gallstones/diagnosis , Korea/epidemiology , Prevalence , Retrospective StudiesABSTRACT
Objective To explore the relationship between smoking, alcohol drinking and gallstone disease in general male population in Guangdong. Methods Each subject received a questionnaire and took an upper abdominal ultrasound examination in a cross-sectional study. Results The prevalence of gallstone disease became higher with the increase of amount of cigarette smoking per day (trend test ?2=5.542, P=0.019) and with the total amount of cigarette smoking in their life (trend test ?2=7.302, P=0.007), these significance remained after controlling well-known risk factors for gallstone disease such as age and body mass index (BMI) (OR=1.269,95%CI: 1.018~1.580 for cigarette smoking per day and OR=1.295, 95%CI: 1.020~1.646 for total ). Little to moderate alcohol drinking (
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We reviewed the results of 25 small-incision cholecystectomies and 79 conventional cholecystectomies performed at Visayas Community Medical Center from January 1, 2000 to January 31, 2002. There were no differences in the mean age and the male to female ratio in both groups. The mean duration of operation for the small-incision cholecystectomy group was 132.2 minutes while it took 133.4 minutes in the conventional cholecystectomy group. Resumption of regular diet in the small-incision cholecystectomy group was 2.5 days while it took 4 days in the conventional cholecystectomy group. Postoperative hospital stay ranged from 3 to 6 days with a mean of 4 days in the small-incision cholecystectomy group. On the other hand, postoperative hospital stay ranged from 4 to 10 days with a mean of 7.3 days in the conventional cholecystectomy group. Complications seen included postoperative fever, intraoperative bleeding, wound infection and bile leak. Overall, our study confirmed the earlier resumption to regular diet and shorter postoperative stay, thus, faster recovery in the small-incision cholecystectomy group. However, no conclusion can be made because of limitations in the study design and the small sample size. (Author)