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Portincasa P, van Erpecum KJ, Di Ciaula A, Wang DQH. The physical presence of gallstone modulates ex vivo cholesterol crystallization pathways of human bile. Gastroenterol Rep (Oxf) 2019; 7:32-41. [PMID: 30792864 PMCID: PMC6375352 DOI: 10.1093/gastro/goy044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cholesterol crystallization is an essential step toward gallstone formation. Although model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cholesterol molecules available for crystallization, this has not been investigated in human bile. METHODS Fresh gallbladder bile was obtained during laparoscopic cholecystectomy from 13 patients with cholesterol (n = 10) or pigment (n = 3) stones. Small cholesterol gallstones were collected from another two patients. Both native and ultrafiltered bile with or without added gallstones was analysed by polarized light microscopy for the presence of arc-like and needle-like anhydrous cholesterol crystals and classic cholesterol monohydrate crystals. Weight of the added stones was evaluated before and after 21 days of bile incubation. RESULTS In unfiltered bile, the presence of stones was associated with a trend towards less anhydrous cholesterol crystals, but significantly more aggregated cholesterol monohydrate crystals. In ultrafiltered bile, the presence of stones tended to inhibit the formation of arc-like or needle-like crystals and was associated with significantly greater amounts of both plate-like and aggregated cholesterol monohydrate crystals. After 21 days of the incubation, stone weight was decreased in both unfiltered (-4.5 ± 1.6%, P = 0.046) and ultrafiltered bile (-6.5 ± 1.5%, P = 0.002). Bile from pigment-stone patients was clear in the absence of stones, but showed early appearance of plate-like and aggregated cholesterol monohydrate crystals in all samples to which cholesterol gallstones were added. CONCLUSIONS The physical presence of cholesterol gallstones in both native and filtered bile greatly influences cholesterol crystallization pathways. Whereas cholesterol monohydrate crystals increase, anhydrous cholesterol crystals tend to be inhibited. Detachment of solid cholesterol crystals from the gallstone surface may explain these findings.
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Affiliation(s)
- Piero Portincasa
- Division of Internal Medicine, Department of Biomedical Sciences and Human Oncology, University Medical School, Bari, Italy
- Corresponding author. Division of Internal Medicine, Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University Medical School, Policlinico, Piazza Giulio Cesare 11, Bari, 70124, Italy. Tel: +39-80-5478892; Fax: +39-80-5478232;
| | - Karel J van Erpecum
- Department of Gastroenterology, University Medical Center, Utrecht, The Netherlands
| | - Agostino Di Ciaula
- Division of Internal Medicine, Hospital of Bisceglie, ASL BAT, Bisceglie, Italy
| | - David Q -H Wang
- Department of Medicine, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Ravikanth VV, Rao GV, Govardhan B, Sasikala M, Subramanyam C, Vivekananda Murthy H, Siva Prasad S, Deepika G, Pradeep R, Nageshwar Reddy D. Polymorphisms in UGT1A1 Gene Predispose South Indians to Pigmentous Gallstones. J Clin Exp Hepatol 2016; 6:216-223. [PMID: 27746618 PMCID: PMC5052425 DOI: 10.1016/j.jceh.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 08/12/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES Pigmentous gallstones occur in South Indians despite significant higher levels of circulating cholesterol. This study was conducted to identify the biochemical and/or genetic causes for the formation of pigmentous gallstones in this ethnic group. METHODS Plasma lipid profile, bile cholesterol, acids, and phospholipid levels were estimated in patients with gall stone disease and age, sex matched controls using standard protocols. Twenty-seven SNPs related to cholesterol and bilirubin metabolism pathway genes were genotyped in the study population using the Sequenom platform. An equilibrium phase diagram involving bile salt-phospholipid-cholesterol was generated to relate phenotype with the genotype. RESULTS There were no significant differences in the lipid profiles between the patients (n = 305) and controls (n = 177). Biliary cholesterol, acids, and phospholipids were significantly different between patients and controls. Single locus analysis revealed association of variants in ABCG6, ABCG8, and UGT1A1 genes with the disease; however when correction was applied as multiple testing was done, only one variant (rs6742078) in UGT1A1 gene was found to be associated with gall stone disease. Equilibrium phase diagram suggested that few samples were in the crystal formation zone. The mutant, but not wild type or heterozygous genotype of SNPs (rs6742078 and rs887829) in UGT1A1 gene, was associated with significantly higher levels of bilirubin. CONCLUSIONS Higher incidence of pigment stones in South Indians could be due to raised serum bilirubin levels that may be ascribed to variant in the UGT1A1 gene involved in glucuronidation of free bilirubin.
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Key Words
- ABCG, 8 ATP-binding cassette, sub-family G (WHITE), member 8
- ABCG6, ATP-binding cassette protein subfamily G, member 6
- DNA, deoxyribose nucleic acid
- GSD, gallstone disease
- HDL, high density lipoprotein
- LDL, low density lipoprotein
- OR, odds ratio
- PXR, pregnane C receptor
- SD, standard deviation
- SNPs, single nucleotide polymorphisms
- UGT1A1 gene
- UGT1A1, UDP glucuronosyltransferase 1 family, polypeptide A1 (UGT1A1)
- bilirubin
- cholesterol gall stones
- pigmentous gall stones
- polymorphisms
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Affiliation(s)
- Vishnubhotla Venkata Ravikanth
- Asian Healthcare Foundation, 6-3-661, Somajiguda, Hyderabad 500082 Telangana, India
- Address for correspondence: Group Leader Genetics, Asian Healthcare Foundation, 6-3-661, Somajiguda, Hyderabad 500082, Andhra Pradesh, India. Tel.: +91 40 23378888x731; fax: +91 40 223324255.Group Leader Genetics, Asian Healthcare Foundation6-3-661, SomajigudaHyderabadAndhra Pradesh500082India
| | - Guduru Venkat Rao
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082 Telangana, India
| | - Bale Govardhan
- Asian Healthcare Foundation, 6-3-661, Somajiguda, Hyderabad 500082 Telangana, India
| | - Mitnala Sasikala
- Asian Healthcare Foundation, 6-3-661, Somajiguda, Hyderabad 500082 Telangana, India
| | | | | | | | - G. Deepika
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082 Telangana, India
| | - Rebala Pradeep
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad 500082 Telangana, India
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Cho E, Jeong D, Paik SR, Jung S. Rod and Vesicular Structures of Cyclosophoraose-Based Ionic Self-assembly. B KOREAN CHEM SOC 2014. [DOI: 10.5012/bkcs.2014.35.8.2537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chen Y, Li F, Liu BW, Jiang BP, Zhang HY, Wang LH, Liu Y. Thermodynamic origin of selective binding of β-cyclodextrin derivatives with chiral chromophoric substituents toward steroids. J Phys Chem B 2010; 114:16147-55. [PMID: 20695496 DOI: 10.1021/jp105821s] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Two β-cyclodextrin derivatives with chiral chromophoric substituents, that is, L- (1) and D-tyrosine-modified β-cyclodextrin (2), were synthesized and fully characterized. Their inclusion modes, binding abilities, and molecular selectivities with four steroid guests, that is, cholic acid sodium salt (CA), deoxycholic acid sodium salt (DCA), glycochoic acid sodium salt (GCA), and taurocholic acid sodium salt (TCA), were investigated by the circular dichroism, 2D NMR, and isothermal titration microcalorimetry (ITC). The results obtained from the circular dichroism and 2D NMR showed that two hosts adopted the different binding geometry, and these differences subsequently resulted in the significant differences of molecular binding abilities and selectivities. As compared with native β-cyclodextrin and tryptophan-modified β-cyclodextrin, host 2 showed the enhanced binding abilities for CA and DCA but the decreased binding abilities for GCA and TCA; however, host 1 showed the decreased binding abilities for all four bile salts. The best guest selectivity and the best host selectivity were K(S)(2-DCA)/K(S)(2-TCA) = 12.6 and K(S)(2-CA)/K(S)(1-CA) = 10, respectively, both exhibiting great enhancement as compared with the corresponding values of the previously reported L- and D-tryptophan-modified β-cyclodextrins. Thermodynamically, it was the favorable enthalpic gain that led to the high guest selectivity and host selectivity.
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Affiliation(s)
- Yong Chen
- Department of Chemistry, State Key Laboratory of Elemento-Organic Chemistry, Nankai University, Tianjin 300071, People's Republic of China
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Abstract
Cholesterol gallstone formation is a complex process and involves phase separation of cholesterol crystals from supersaturated bile. In most cases, cholesterol hypersecretion is considered the primary event in gallstone formation. The sterol is transported through the hepatocytic canalicular membrane by ABCG5-G8. Expression of this transport protein is regulated by transcription factor Liver X Receptor-alpha, which may be responsible for biliary hypersecretion. Hydrophobic bile salt pool, bile concentration, excess pronucleating mucin, and impaired gallbladder and intestinal motility are secondary phenomena in most cases but nevertheless may contribute to gallstone formation.
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Affiliation(s)
- Niels Gerard Venneman
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Monte MJ, Marin JJG, Antelo A, Vazquez-Tato J. Bile acids: Chemistry, physiology, and pathophysiology. World J Gastroenterol 2009; 15:804-16. [PMID: 19230041 PMCID: PMC2653380 DOI: 10.3748/wjg.15.804] [Citation(s) in RCA: 360] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The family of bile acids includes a group of molecular species of acidic steroids with very peculiar physical-chemical and biological characteristics. They are synthesized by the liver from cholesterol through several complementary pathways that are controlled by mechanisms involving fine-tuning by the levels of certain bile acid species. Although their best-known role is their participation in the digestion and absorption of fat, they also play an important role in several other physiological processes. Thus, genetic abnormalities accounting for alterations in their synthesis, biotransformation and/or transport may result in severe alterations, even leading to lethal situations for which the sole therapeutic option may be liver transplantation. Moreover, the increased levels of bile acids reached during cholestatic liver diseases are known to induce oxidative stress and apoptosis, resulting in damage to the liver parenchyma and, eventually, extrahepatic tissues. When this occurs during pregnancy, the outcome of gestation may be challenged. In contrast, the physical-chemical and biological properties of these compounds have been used as the bases for the development of drugs and as pharmaceutical tools for the delivery of active agents.
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de Bruin GJ, Petruzzelli M, Venneman NG, van Minnen LP, Portincasa P, Konikoff FM, van Erpecum KJ. Effects of Aramchol on
in vitro
bile cholesterol crystallization and bile acid detergency. EUR J LIPID SCI TECH 2008. [DOI: 10.1002/ejlt.200700227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gijs J. de Bruin
- Gastrointestinal Research Unit, Departments of Gastroenterology and Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michele Petruzzelli
- Gastrointestinal Research Unit, Departments of Gastroenterology and Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Section of Internal Medicine, Department of Internal and Public Medicine, University of Bari, Bari, Italy
| | - Niels G. Venneman
- Gastrointestinal Research Unit, Departments of Gastroenterology and Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L. Paul van Minnen
- Gastrointestinal Research Unit, Departments of Gastroenterology and Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Piero Portincasa
- Section of Internal Medicine, Department of Internal and Public Medicine, University of Bari, Bari, Italy
| | - Fred M. Konikoff
- Department of Gastroenterology Meir Medical Center, Kfar Saba, and the Minerva Center for Gallstones and Lipid Metabolism in the Liver, Tel Aviv University, Tel Aviv, Israel
| | - Karel J. van Erpecum
- Gastrointestinal Research Unit, Departments of Gastroenterology and Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Higuchi WI, Tzeng CS, Chang SJ, Chiang HJ, Liu CL. Estimation of cholesterol solubilization by a mixed micelle binding model in aqueous tauroursodeoxycholate:lecithin:cholesterol solutions. J Pharm Sci 2008; 97:340-9. [PMID: 17786967 DOI: 10.1002/jps.21096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In order to interpret the clinical efficacy of conjugated ursodeoxycholate (UDC) in cholesterol (Ch) gallstone patients, the Ch solubilization in mixed micelles in 40:40:32 mM tauroursodeoxycholate (TUDC):taurochenodeoxycholate (TCDC):lecithin (L) and 80:32 mM TUDC:L systems was estimated by using a model of Ch binding to mixed micelles. The Ch solubilization limit in mixed TUDC:L micelles was found to be higher than that in mixed TUDC:TCDC:L micelles. In the 80:32 mM TUDC:L system, the dissolution of the Ch pellet decreased after vesicles (liposomes) formed on the surface of the Ch pellet whereas the dissolution of microcrystalline Ch was rapid before and after vesicle formation in the solution, indicating that the total surface area of solid Ch exposed to the solution may be another important factor in inducing the dissolution of Ch gallstones. These phenomena suggest that although vesicles, occasionally formed in the bile of patients under the therapy of conjugated UDC, make a contribution to the solubilization of Ch gallstones, the model of Ch binding to mixed TUDC:L micelles can be used to estimate Ch solubility in TUDC:L system.
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Affiliation(s)
- William I Higuchi
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT 84112, USA
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Liu Y, Zhang N, Chen Y, Chen GS. Secondary assembly of bile salts mediated by β-cyclodextrin–terbium(III) complex. Bioorg Med Chem 2006; 14:6615-20. [PMID: 16784860 DOI: 10.1016/j.bmc.2006.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Revised: 05/31/2006] [Accepted: 06/01/2006] [Indexed: 10/24/2022]
Abstract
A fluorescent cyclodextrin-Tb(III) complex is successfully synthesized and can include bile salts in its hydrophobic cavities. Therefore, it can efficiently induce the secondary assembly of small bile salt primary micelles to large micelle aggregates, and the aggregation process can be easily observed by transmission electron microscopy (TEM) and fluorescence microscopy.
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Affiliation(s)
- Yu Liu
- Department of Chemistry, State Key Laboratory of Elemento-Organic Chemistry, Nankai University, Tianjin 300071, PR China.
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van Minnen LP, Venneman NG, van Dijk JE, Verheem A, Gooszen HG, Akkermans LMA, van Erpecum KJ. Cholesterol crystals enhance and phospholipids protect against pancreatitis induced by hydrophobic bile salts: a rat model study. Pancreas 2006; 32:369-75. [PMID: 16670619 DOI: 10.1097/01.mpa.0000220861.78248.1f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The role of bile composition in the pathogenesis of biliary pancreatitis is unknown. The objective of this experiment was to explore the potential role of bile salts, phospholipids, and cholesterol crystals in the pathogenesis of biliary pancreatitis in a rat model. METHODS Model systems composed of taurodeoxycholate (TDC), mixed bile salts (MBS), or tauroursodeoxycholate (TUDC) [in 10 mM phosphate-buffered saline (PBS), pH 7.4], with or without cholesterol crystals or phosphatidylcholine, were infused into bile ducts of male Sprague-Dawley rats. Twenty-four hours later, animals were killed for histopathologic scoring of (peri)pancreatic inflammation. RESULTS : Severity of acute pancreatitis depended on bile salt hydrophobicity (TDC > MBS >> TUDC = PBS; histopathologic scores: 25.6 +/- 0.5, 23.0 +/- 1.5, 14.4 +/- 2.2, 14.8 +/- 1.0, respectively; P < 0.001), with corresponding differences in serum lipase concentration. Phosphatidylcholine protected against detrimental effects of TDC at physiological, but not at low, concentrations (scores: 19.5 +/- 2.3 vs 28.3 +/- 1.9 in case of Phosphatidycholine/(TDC + Phosphatidycholine) ratios 0.25 or 0.05, respectively). Cholesterol crystals increased severity of pancreatitis in model systems containing TDC or MBS, but not TUDC or PBS (33.2 +/- 0.4, 29.6 +/- 1.2, 18.6 +/- 1.5, 18.5 +/- 2.2, respectively; P < 0.001). CONCLUSIONS In the rat model, hydrophobic bile salts and cholesterol crystals aggravate biliary pancreatitis, whereas phospholipids have a protective effect.
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Affiliation(s)
- L Paul van Minnen
- Gastrointestinal Research Unit, Departments of Gastroenterology and Surgery, University Medical Center Utrecht, The Netherlands.
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Abstract
Several risk factors for cholesterol gallstone formation in the general population have been identified. There is a strongly increased risk of gallstone disease during prolonged fasting, rapid weight loss, total parenteral nutrition, and somatostatin(-analogue) treatment. The annual risk of biliary colic and gallstone complications in asymptomatic gallstone carriers has been investigated sparsely. In asymptomatic and symptomatic gallstone carriers, treatment with the hydrophilic bile salt ursodeoxycholic acid (UDCA) has been claimed to reduce the risk of biliary colic and gallstone complications such as acute cholecystitis and acute pancreatitis. Also, prophylactic cholecystectomy could be beneficial in certain subgroups of asymptomatic gallstone carriers. However, randomized, double-blind, placebo-controlled trials are lacking. In this review, strategies for the prevention of gallstone formation in the general population and in high-risk conditions are dealt with. Also, strategies for the prevention of biliary colic and gallstone complications in asymptomatic and symptomatic gallstone carriers are discussed.
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Affiliation(s)
- Niels G Venneman
- Gastrointestinal Research Unit, Department of Gastroenterology, University Medical Center Utrecht, The Netherlands.
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Venneman NG, Buskens E, Besselink MGH, Stads S, Go PMNYH, Bosscha K, van Berge-Henegouwen GP, van Erpecum KJ. Small gallstones are associated with increased risk of acute pancreatitis: potential benefits of prophylactic cholecystectomy? Am J Gastroenterol 2005; 100:2540-50. [PMID: 16279912 DOI: 10.1111/j.1572-0241.2005.00317.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Pancreatitis is a severe complication of gallstone disease with considerable mortality. Small gallstones may increase the risk of pancreatitis. Our aims were to evaluate potential association of small stones with pancreatitis and potential beneficial effects of prophylactic cholecystectomy. METHODS Stone characteristics were determined in patients with biliary pancreatitis (115), obstructive jaundice due to gallstones (103), acute cholecystitis (79), or uncomplicated gallstone disease (231). Sizes and numbers of gallbladder and bile duct stones were determined by ultrasonography and endoscopic retrograde cholangiopancreatography, respectively. Effects of prophylactic cholecystectomy were assessed by decision analyses with a Markov model and Monte Carlo simulations. RESULTS Patients with pancreatitis or obstructive jaundice had more and smaller gallbladder stones than those with acute cholecystitis or uncomplicated disease (diameters of smallest stones: 3 +/- 1, 4 +/- 1, 8 +/- 1, and 9 +/- 1 mm, respectively, p < 0.01). Bile duct stones were smaller in case of pancreatitis than in obstructive jaundice (diameters of smallest stones: 4 +/- 1 vs 8 +/- 1, p < 0.01). Multivariate analysis identified old age and small stones as independent risk factors for pancreatitis. Decision analysis in a representative group of patients with small (<or=5 mm) gallstones (5,000 patients, 67% females, 45 yr old, 10-yr follow-up) indicates that life-years may be gained or lost by cholecystectomy, depending on incidence and mortality of pancreatitis. CONCLUSIONS Small gallstones are associated with pancreatitis. Prophylactic cholecystectomy may lead to gain or loss of life-years in patients with small stones, depending on incidence and mortality of pancreatitis.
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Affiliation(s)
- Niels G Venneman
- Gastrointestinal Research Unit, Department of Gastroenterology, University Medical Center, Utrecht, The Netherlands
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Venneman NG, Renooij W, Rehfeld JF, VanBerge-Henegouwen GP, Go PMNYH, Broeders IAMJ, van Erpecum KJ. Small gallstones, preserved gallbladder motility, and fast crystallization are associated with pancreatitis. Hepatology 2005; 41:738-46. [PMID: 15793851 DOI: 10.1002/hep.20616] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Acute pancreatitis is a severe complication of gallstones with considerable mortality. We sought to explore the potential risk factors for biliary pancreatitis. We compared postprandial gallbladder motility (via ultrasonography) and, after subsequent cholecystectomy, numbers, sizes, and types of gallstones; gallbladder bile composition; and cholesterol crystallization in 21 gallstone patients with previous pancreatitis and 30 patients with uncomplicated symptomatic gallstones. Gallbladder motility was stronger in pancreatitis patients than in patients with uncomplicated symptomatic gallstones (minimum postprandial gallbladder volumes: 5.8 +/- 1.0 vs. 8.1 +/- 0.7 mL; P = .005). Pancreatitis patients had more often sludge (41% vs. 13%; P = .03) and smaller and more gallstones than patients with symptomatic gallstones (smallest stone diameters: 2 +/- 1 vs. 8 +/- 2 mm; P = .001). Also, crystallization occurred much faster in the bile of pancreatitis patients (1.0 +/- 0.0 vs. 2.5 +/- 0.4 days; P < .001), possibly because of higher mucin concentrations (3.3 +/- 1.9 vs. 0.8 +/- 0.2 mg/mL; P = .04). No significant differences were found in types of gallstones, relative biliary lipid contents, cholesterol saturation indexes, bile salt species composition, phospholipid classes, total protein or immunoglobulin (G, M, and A), haptoglobin, and alpha-1 acid glycoprotein concentrations. In conclusion, patients with small gallbladder stones and/or preserved gallbladder motility are at increased risk of pancreatitis. The potential benefit of prophylactic cholecystectomy in this patient category has yet to be explored.
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Affiliation(s)
- Niels G Venneman
- Gastrointestinal Research Unit, Departments of Gastroenterology and Surgery, University Medical Center, 3508 GA Utrecht, The Netherlands
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