Efecto de la ingesta de vitamina C en el proceso de formación de cálculos biliares de colesterol / Effects of vitamin C administration on cholesterol gallstone formation

Background: Biliary cholesterol is transported by vesicles and micelles. Cholesterol microcrystals are derived from thermodynamically unstable vesicles. In experimental animals vitamin C deficiency leads to a super-saturation of biliary cholesterol and to the formation of gallstones. Aim: To search for a possible relationship between serum levels of vitamin C and the formation of cholesterol gallstones in patients with cholelithiasis. Material and Methods: Thirteen patients with cholelithiasis and a programmed surgical intervention were treated with 2 g/day of vitamin C per os for two weeks before surgery. Forty nine patients subjected to a cholecystectomy not supplemented with vitamin C were studied as controls. Plasma concentrations of vitamin C and lipid profiles were measured. The cholesterol saturation index, crystallization time, cholesterol and phospholipid content in vesicles and micelles, separated by gel filtration chromatography, were studied in bile samples obtained from the gallbladder. Results: Vitamin C supplementation did not change significantly plasma lipids and bile lipid concentrations. However, in supplemented patients, significant reductions in vesicular cholesterol content (6.5 ± 4.8% compared to 17.9 ± 14.0% in the control group; p < 0.05) and vesicular cholesterol/phospholipid ratio (0.71 ± 0.53 compared to 1.36 ± 1.15 in controls; p < 0.05), were observed. Conclusions: Vitamin C administration may modify bile cholesterol crystallization process, the first step in cholesterol gallstone formation.

Tratamento clínico da litíase biliar e hipocondria / Clinical treatment of biliary lithiasis and hypochondria

Além das indicações fundamentais para se obter a dissolução clínica da litíase biliar, sabe-se por experiência que a constância na tomada da medicação é também fundamental para o sucesso do tratamento. Acompanhado pacientes em uso de medicação para dissolução dos cálculos, o autor verificou casos em que a não tomada (esquecimento) por apenas três dias já causa aumento da consistência estrutural dos cálculos no controle radiológico. O hipocondríaco, que é fascinado pelo uso de remédios, apresenta a característica da prazerosa constância na tomada de medicações. O levantamento de 30 casos seqüenciais de pacientes submetidos à dissolução considerados hipocondríacos, comparados com o mesmo número de pessoas mais equilibradas, mostrou significativa diferença. O autor obteve a dissolução completa nos 30 casos de hipocontríacos, enquanto que no grupo de controle a dissolução foi verificada em 19 casos

Expression of MUC3, MUC5AC, MUC6 and Epidermal Growth Factor Receptor in Gallbladder Epithelium according to Gallstone Composition / 대한소화기학회지

BACKGROUND/AIMS: Gallbladder (GB) mucin is one of the key factors in the gallstone formation. However, there is little information about the diversity of mucin secretion according to the stone composition. Epidermal growth factor receptor (EGFR) functions in proliferation including mucin secreting goblet cell hyperplasia. We compared the expressions of MUC3, MUC5AC, MUC6 and EGFR in the GB epithelium with cholesterol gallstones (GB-chol) group and pigment gallstones (GB-pig group). METHODS: GBs from elective laparoscopic cholecystectomy for the gallstone disease were studied. Stone composition was analyzed by the spectrophotometer. Immunohistochemical stain was performed using each monoclonal antibody. The percentage of stained proportion was scored by the NIH image program and the results were compared between both groups. RESULTS: Total 20 patients were enrolled (10 patients with cholesterol gallstones, 10 patients with pigment gallstones). The percentages of stained proportion for MUC3, MUC5AC, and MUC6 were 42+/-27%, 31+/-15%, and 17+/-9%, respectively in GB-chol group and 32+/-22%, 33+/-23%, and 15+/-10%, respectively in GB-pig group (p>0.05). The expression of EGFR was 50% (5/10) in the GB-chol group and 80% (8/10) in the GB-pig group respectively. CONCLUSIONS: There was no difference in the expressions of MUC3, MUC5AC, and MUC6 between the two groups. Further studies are needed to elucidate the role of EGFR in the gallstore formation.

Epidemiological correlation between chromium content in gallstones and cholesterol in blood.

The authors measured the chromium in gallstones and bile from patients in three areas (Kawasaki (a city adjacent to Tokyo) in Japan, Chiang Mai and Bangkok in Thailand) by means of neutron activation analysis. The chromium in three types of gallstones (cholesterol, pigment, and rare stones) and bile from patients living in Bangkok were evidently larger than those from patients living in Kawasaki and Chiang Mai. The high chromium intake by Bangkok patients continued from the start of gallstone formation until the time the stones were removed. The total-cholesterol, triglyceride, and hemoglobin A(1C) levels in the blood from Bangkok residents with high chromium intake over a long period were clearly lower than those of Japanese and Chiang Mai residents. The authors showed that the high dietary intake of chromium over a long period may play a role in the lowering of total-cholesterol, triglyceride, and hemoglobin A(1C) in blood.

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.

Role of duodenal bile crystal analysis in idiopathic pancreatitis.

BACKGROUND/AIM: The aim of this study was to find out the incidence and clinical use of duodenal bile crystal analysis in patients presenting with idiopathic pancreatitis. MATERIALS AND METHODS: Sixty consecutive patients with acute pancreatitis were studied. They were divided into two subgroups (known and unknown causes). Sixty patients were used as controls and divided into 3 subgroups (n = 20 each). The patients of acute pancreatitis with severe or life threatening complications or those requiring surgical interventions were excluded. Bile samples from both groups were analyzed for presence or absence of crystals. RESULTS: The maximum age incidence of acute pancreatitis was in the fifth decade (41-50 years). The M/F ratio was 3.6:1. Recurrent acute pancreatitis was observed in 26.6% cases (20% idiopathic vs. 6.6% known aetiology). Twenty-five percent of the control sub group (n = 20) cases of cholelithiasis without history of pancreatitis had positive microcrystals in their bile sample. In patients with idiopathic pancreatitis (n = 18), 7 cases (11.6%) had crystals in the bile. In those with known causes of pancreatitis (n = 42), 33 cases (55%) had positive crystals in the bile. CONCLUSION: Thirty percent of our patients had idiopathic acute pancreatitis with a high rate of clinical recurrence (20%). Duodenal bile crystal analysis detected 7 cases of microlithiasis out of 18 cases in this group and suggested an aetiology. This procedure should be used more often.

Predicting the composition of gallstones by infrared spectroscopy.

AIM: To determine the composition of gallstones in South India by comparing visual assessment with graphic interpretation of infrared spectra. METHODS: Infrared spectroscopy (IRS) was used in qualitative analysis of 168 gallstones from Tamilnadu, Kerala and Karnataka and compared with visual interpretation. The spectrum of cholesterol, calcium bilirubinate and calcium carbonate for each stone was correlated with visual inspection. RESULTS: Fifty four percent of gallstones were of pigment variety, 43% were of mixed and the remaining 3% were cholesterol gallstones as categorised by visual interpretation. Based on infrared spectrocopic interpretation the percentages were 58%, 39% and 2% respectively. There was a good agreement between the visual inspection and IRS in classification of gallstones (Kappa value 85%; 95% CI 77-93%). CONCLUSION: Visual inspection of gallstones can predict the composition of gallstone with good accuracy and was comparable to infrared spectroscopic interpretation.

Composition of gallstones and sequential events in biliary lithogenesis--is it different in south India compared to north?

AIMS: This study was carried out to determine the gross type and composition of gallstones from South India in order to compare it with published results from the North to see whether the sequential events in biliary lithogenesis are different in these two geographical areas. MATHODOLOGY: A total of 76 stones collected from various hospitals in South India including JIPMER were analysed using X-ray crystallography. Patient characteristics were recorded. Gross typing was done according to Bockus' morphological criteria. RESULTS: Patients with gallstones in South India were found to be older in age with near equal gender distribution. Pigment calcium stones accounted for 56.5%, pigment stones for 17.2% and mixed stones for 14.2% of gallstones. Bilirubin and its salts were the most frequently identified class of compounds by crystallography. Analysis of gallstones layer by layer revealed equal distribution of bilirubin compounds between the centre and outer layers except crystalline bilirubin which was found only in outer layers. Vaterite, a polymorph of calcium carbonate was found in the nucleus, whereas vaterite and aragonite were found in the outer layers. Combination of anhydrous cholesterol and cholesterol II were found in the nucleus. Epitaxial relationship were found to hold good except for vaterite and aragonite. CONCLUSION: Gallstones from South India are probably due to infection rather than supersaturation as evidenced by predominance of pigment calcium stones and various types of bilirubin and calcium carbonate compounds. Vaterite is important for nucleation. Further growth of stones is influenced by epitaxial relationship. These findings are dissimilar to that reported from North India indicating a different stimulus for stone precipitation in these two areas.

Tipo, número e tamanho de cálculos da vesícula biliar: estudo prospectivo de 300 casos de colelitíase / Type, number and size of stones of the gallbladder: prospective study of 300 cases of cholelithiasis

O nosso objetivo é determinar prospectivamente o número, tamanho e tipo de cálculos da vesícula biliar de trezentos pacientes consecutivos submetidos à colecistectomia. O tipo de cálculo foi correlacionado com o sexo e idade dos pacientes, o tamanho e o número de cálculos e a presença de colecistite aguda e de displasia da vesícula biliar. Cálculo de colesterol foi encontrado em 262 pacientes (87,3 por cento), pigmentar negro em 33 (11 por cento) e pigmentar marrom em cinco (1,7 por cento). Todos os tipos de cálculos foram mais comuns no sexo feminino e aumentaram com a idade. O cálculo de colesterol foi mais comum em todas as faixas etárias. O número de cálculos variou de um a 465, sendo que a metade dos pacientes apresentou menos do que cinco cálculos. Cálculo único foi encontrado em 65 dos 262 pacientes (24,8 por cento) com cálculo de colesterol, em um dos cinco pacientes (20 por cento) com cálculo pigmentar marrom e em nenhum paciente com cálculo pigmentar negro. A incidência de colecistite aguda foi similar para os três tipos de cálculos. Não houve diferença na incidência de displasia da vesícula biliar em relação ao número, tipo e tamanho de cálculo. Conclui-se deste estudo que os cálculos de colesterol são os mais comuns da vesícula biliar, independente da idade e do sexo dos pacientes. Apesar do número de cálculos ser extremamente variável, metade dos pacientes submetidos à colecistectomia por litíase apresenta menos do que cinco cálculos. Pacientes com cálculo pigmentar preto não apresentam cálculo único

Comparative studies on iodine levels in gallstones and bile of Japanese and Thais (Chiang Mai and Bangkok).

We measured the iodine content of gallstones and bile from patients in three areas (Kawasaki in Japan, and Chiang Mai and Bangkok in Thailand) by means of neutron activation analysis. The mean values for iodine content in three types of gallstones (cholesterol, pigment and rare stones) and bile from patients living in Chiang Mai were clearly smaller than those from patients living in Kawasaki and Bangkok. The low iodine intake by Chiang Mai patients continued from the start of gallstone formation until the time when the stones were excised, and the iodine intake was low when bile was collected. The PBI levels in the sera of Chiang Mai residents with low iodine intake over a long period were clearly lower than those of Bangkok patients with normal intake, and the levels in goiter patients were similar to those in healthy people and patients with gallstones among Chiang Mai residents.

Estudo termoanalítico e caracterização química da litíase biliar / Thermal analysis study and chemical caracterization of the biliar lithiasis

Esse trabalho relata a caracterização química e termoanalítica de cálculos biliares de pacientes de ambos os sexos, submetidos a colecistectomia. Os resultados foram obtidos utilizando-se as seguintes técnicas analíticas: termogravimetria, termogravimetria derivada, calorimetria exploratória diferencial e análise elementar. A associação dos resultados, devido a presença ou não de colesterol e material inorgânico, sugere uma classificação inovadora com relação aos diferentes tipos de cálculos biliares encontrados (au)

Composition of gallstones in Coimbatore District of Tamil Nadu State.

BACKGROUND: Gallstones in northern India are predominantly of the cholesterol type; such information on gallstones in southern India is scant. AIM: To analyze the composition of gallstones from patients residing in Coimbatore District in Tamil Nadu State. METHODS: The stones were classified using the Bernhoft criteria and was correlated with the morphological characteristics. RESULTS: Of the 105 gallstones analyzed, 67 (63.8%) were of the pigment variety and 36 (34.8%) of the intermediate/mixed type. There were only two cholesterol stones. The mean proportions of cholesterol, bilirubin and calcium in the pigment and intermediate stones were 7.1%, 26.1% and 7.8% and 30.2%, 18.4% and 6.3%, respectively. The mean proportion of bilirubin in the pigment stones was higher than in the intermediate type. Morphologically, pigment stones were black in 55% and amorphous in 63%; the intermediate stones were hard in 50% and of variegated color ranging from yellow to ivory white in 61%; both cholesterol stones were multiple, hard and brown. CONCLUSIONS: There is a predominance of pigment and intermediate gallstones (98%) in this district. These stones have reduced cholesterol and an increase in bilirubin and calcium proportions.

"Changing trends (clinico-biochemical) in gall-bladder stone disease"--an observation.

Present study has been undertaken to know the causative factors responsible for change in trend of gall-stone disease from middle aged, fertile, fat females to young asthenic females in twenties. Our findings reveal high incidence of gall stone formation in non-obese young females. Average fat consumption in non-obese patients was less (17%) than that of obese (26%). However, use of oral contraceptives was high in non-obese females and maximum users were in young age group while in obese in middle age group. Bilirubin content in gall bladder stones of non-obese was significantly more than that of obese (p < 0.01) whereas cholesterol content in gall bladder stones of obese was significantly high when compared to non-obese subjects. Analysis of bile showed significant increase in bilirubin and calcium level of non-obese when compared to control and obese subjects whereas phosphorus levels were significantly decreased in the bile of non obese subjects. These findings suggest that in non-obese females less intake of fat, early use of oral contraceptives, higher contents of bilirubin and calcium and low content of phosphorus in bile may be responsible for gall stone formation.

Gallstone disease in the Himalayas (Sikkim and north Bengal): causation and stone analysis.

OBJECTIVES: To know the extent of gallstone disease in Sikkim and North Bengal. METHODS: 487 (14.4%) patients with gallstones were diagnosed among 3375 patients with dyspepsia in 3 years. All patients with gallstone were evaluated based on a predefined questionnaire. Abdominal sonography was performed and obesity index was calculated. Gallstones retrieved at surgery from 29 patients were subjected to infra-red spectroscopic analysis. RESULTS: The patients with gallstones included 375 women with average age of 40 years and 112 men with average age of 48.7 years. 15.7% of the women were nulliparous, 12% had one child and 23% had two children each. 73% of patients were of normal weight and 97% were non-vegetarians. Only cholesterol gallstones were found in these patients. CONCLUSIONS: Gallstones are common in Sikkim and North Bengal among dyspeptics. A majority of patients are of normal weight. The disease occurs a decade earlier in women, most of whom have only up to two children.

Cholesterol rich gall stones; prevalence in patients of quetta valley

OBJECTIVE: To analyze the gall stones common to the patients of Quetta valley and relate it with certain possible causes. DESIGN: Case study. SETTING: Around 200 gall stones were obtained from 72 patients admitted in Civil Hospital Quetta and other Private hospitals. PERIOD: March 1993 to February 1995. SUBJECTS: Out of 72, 62 patients were female of age in between 35 and 65 and the rest were male patients of age in between 32 and 65. METHODOLOGY: Various biochemical and infrared spectrophotometric methods were employed to analyze the composition of theses stones. Trace metals were determined quantitatively by atomic absorption spectrophotometer. The study revealed that 88.8% of the total stones were rich in cholesterol content while 8.4% were pigmented stones and 2.8% were mixed stones. The gall stones occur more frequently in female as compared to males. Dietary habits and disturbed mineral metabolism seems to play a vital role in the formation of gall stones

Mercury content in the gallstones and bile of Thai people (Chiang Mai and Bangkok) and Japanese.

Mercury contents in the gallstones and bile of patients living in Thailand (Chiang Mai and Bangkok) and Japan were studied by neutron activation analysis. The correlation between contents in the gallstones and bile, and the amount of mercury in the diet and environment was investigated by comparing the contents in patients living in three different areas. The content in the bile of the Japanese patients was significantly greater than that of the Thai patients. The distribution of mercury contents in the pigment and rare stones of patients living in Bangkok indicated a bipolarity. However, the distribution of the contents in cholesterol, pigment, and rare stones of Japanese patients did not indicate a bipolarity. Bipolarity would indicate the amount of mercury in dietary foods, and the pollution level of mercury. The mercury contents in the gallstones and bile would reflect the amount of mercury in the diet and environment.

Gallstones

Gallstone prevalence is correlated with geographical and ethnic variations. It is more prevalent in Western communities. There are evidences for a high prevalence in Saudi Arabia. According to their chemical constitutes, stones are classified into cholesterol, mixed and pigment stones. Three main factors, saturation, gallbladder function and nucleation defect are implemented in the pathogenesis of stone formation. Majority of gallstones patients are asymptomatic. Dyspeptic symptoms are not specific. Ultrasonography has become the method of choice for screening and diagnosis of gallstones. Cholecystoscintigraphy is accurate in the diagnosis of acute cholecystitis, biliary obstruction and bile leak. Treatment of gallstones will be discussed in the following issue