Primary choledocholithiasis occurrence and recurrence is synergetcally modulated by the bile microbiome and metabolome alternations

AIMS

Primary choledocholithiasis is a common digestive disease with high morbidity and relapse. However, the compositions and functions of the bile microbial ecosystem and the pathogenesis of microfloral regulation of host metabolism resulting in stone formation are poorly understood.

MAIN METHODS

Biliary samples collected from patients with acute cholangitis induced by benign biliary stricture (nonlithiasis group, n = 17) and primary choledocholithiasis (lithiasis group, n = 33) were subjected to multiomics analyses. Furthermore, clinicopathological features collected over a 24-month follow-up period were examined to evaluate the predictive value of candidate microbes.

KEY FINDINGS

Five alpha diversity indices of the bile microbiome were significantly decreased in the lithiasis group. Furthermore, we identified 49 differential bile flora between the two groups, and the relative abundances of 6 bacteria, Actinobacteria, Actinobacteriota, Staphylococcales, Micrococcales, Altererythrobacter and Carnobacteriaceae, were associated with primary choledocholithiasis relapse conditions. Multiomics analyses showed that specific changes in disease-related bacterial taxa were closely related to metabolite variation (low-molecular weight carboxylic acids, sterol liquid and acylcarnitine), which might reflect disease prognosis. According to microbiomic and metabolomic pathway analyses, we revealed that bacterial infections, microbiota-derived amino acid metabolites and secondary bile acid-related pathways were significantly enriched in the stone-formation group, suggesting a novel host-microbial metabolic mechanism of primary choledocholithiasis.

SIGNIFICANCE

Our study first indicates bile host-microbial dysbiosis modulates the abnormal accumulation of metabolites might further disrupt calcium homeostasis and generate insoluble saponification. Additionally, we determined the predictive value of Actinomycetes phylum reduction for recurrence in primary common bile duct stone patients.

Detection of Helicobacter pylori DNA in bile and gallstone of patients with primary choledocholithiasis

AIM: To detect Helicobacter pylori (H. pylori) DNA in bile and gallstone of patients with primary choledocholithiasis.

METHODS: Thirty-two patients with primary choledocholithiasis (experiment group) and 30 control subjects (control group) were included in the study. All the patients underwent endoscopic retrograde cholangiopancreatography (ERCP). H. pylori DNA in bile and gallstone was detected by real-time PCR.

RESULTS: The cycle threshold (Ct) value obtained from bile of patients with primary choledocholithiasis was significantly higher than that from bile of control subjects (16.78 ± 9.28 vs 3.75 ± 7.71, P < 0.01). No significant differences were noted inH. pylori DNA levels in bile and gallstone among patients with bile pigment calculi, those with cholesterol stones and those with mixed stones (P > 0.05).

CONCLUSION: H. pylori DNA can be detected in bile and gallstone of patients with primary choledocholithiasis. H. pylori DNA level is not correlated with stone type. H. pylori present in bile and gallstone of patients with primary choledocholithiasis may play an important role in the development of primary choledocholithiasis.