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PubMed1994

Cholelithiasis and acromegaly: therapeutic strategies.

OBJECTIVE: The aims of this study were (i) to evaluate gall-bladder form and contents, (ii) to assess the prevalence of gallstones in acromegalic patients before octreotide treatment and the incidence of gallstone formation in patients with acromegaly during long-term (6-90 months, mean 44 months) octreotide treatment, and (iii) to test the efficacy of ursodeoxycholic acid in preventing and treating octreotide-induced cholelithiasis. DESIGN: Forty-nine patients (23 men and 26 women, aged 19-81 years) were studied by repeated gall-bladder ultrasonography performed at baseline and then every 6 months during octreotide therapy. All ultrasound scans were evaluated by the same radiologist. Statistical analysis was performed using the Chi-squared and regression analysis tests. RESULTS: Asymptomatic stones were recorded in 13/49 patients (26.5%) prior to octreotide treatment (the prevalence of cholelithiasis in the Italian population is 9.5% in men and 18.9% in women). During octreotide therapy gallstones developed in 10/36 patients (27.7%). No significant correlations with sex, age, body mass index, duration of the disease, daily dose and duration of octreotide therapy, altered gall-bladder form, family history of gallbladder stones, basal plasma values of cholesterol and triglycerides were found between the patients (10/36) who developed stones during octreotide treatment and the ones who did not (26/36). Fourteen patients (10 with newly developed stones and four with cholelithiasis diagnosed prior to octreotide) were put on ursodeoxycholic acid at the daily dose of 10 mg/kg. Gallstones completely disappeared in 6/14 patients (42.8%; five patients with newly developed stones and one with stones prior to octreotide therapy) after a mean of 30.8 months of ursodeoxycholic acid treatment. In addition, seven patients were treated with ursodeoxycholic acid at the preventive dose of 450 mg, administered as a once-a-day oral preparation in the evening. However, stones developed in one of these seven patients who was thereafter cured (gallstones completely disappeared) by the therapeutic dose of ursodeoxycholic acid of 10 mg/kg/day after 23 months of treatment. CONCLUSIONS: This study indicates that (i) acromegaly by itself is correlated with a high prevalence of gallbladder stones, (ii) the long-term treatment with octreotide increases the incidence of cholelithiasis, and (iii) ursodeoxycholic acid is useful in the treatment of gallstones in acromegalic patients but its prophylactic effect in patients on octreotide treatment requires further assessment.

Acromegaly↗

PubMed2003

Association of the presence of Helicobacter in gallbladder tissue with cholelithiasis and cholecystitis.

The presence of Helicobacter DNA species has been investigated in the biliary epithelium of patients with biliary diseases. However, conflicting results have been observed that may have been due to the small number of subjects studied, difficulty in obtaining a healthy control group, absence of controlling for confounding factors, or differences among populations. Therefore, we investigated the presence of Helicobacter species by culture and nested PCR of 16S rRNA genes in gallbladder tissue and bile from 46 Brazilian subjects with and 18 without cholelithiasis. The control group was mainly composed of liver donors and of patients who had submitted to cholecystectomy as part of the surgical treatment for morbid obesity. No Helicobacter species were grown from the bile or gallbladder tissues. Helicobacter DNA was detected in the gallbladder tissue and bile from 31.3 and 42.9% of the patients, respectively. In a logistic regression model, cholelithiasis was positively and independently associated with the female gender (P = 0.02), increasing age (P = 0.002), and the presence of Helicobacter DNA in the gallbladder tissue (P = 0.009). The presence of Helicobacter DNA in the bile was not associated with cholelithiasis (P = 0.8). A significant association between the presence of Helicobacter DNA in the gallbladder epithelium and histological cholecystitis, even after adjusting for gender and age (P = 0.002), was also observed. The sequences of the 16S rRNA genes were >99% similar to that of Helicobacter pylori. In conclusion, our results support the hypothesis that Helicobacter is associated with the pathogenesis of human cholelithiasis and cholecystitis.

Adult↗

PubMed2006

Aberrant maspin expression in gallbladder epithelium is associated with intestinal metaplasia in patients with cholelithiasis.

OBJECTIVE: Aberrant expression of maspin protein related to DNA hypomethylation in the promoter region is frequently observed in gallbladder carcinomas, whereas the non-tumorous gallbladder epithelium is maspin negative. We investigated maspin expression in non-tumorous gallbladder epithelium in patients with cholelithiasis. METHODS: An immunohistochemical study of maspin expression was performed in 69 patients with cholelithiasis and 30 patients with gastric cancer without cholelithiasis. RESULTS: Immunoreactivity for maspin was observed in focal and patchy regions of the gallbladder epithelium. Positive immunoreactivity for maspin was significantly associated with the presence of intestinal metaplasia in patients with cholelithiasis (p<0.05). CONCLUSION: The high incidence of aberrant maspin expression in both intestinal metaplasia and carcinoma of the gallbladder supports the assumption that intestinal metaplasia of the gallbladder may predispose to gallbladder carcinoma.

Adult↗

PubMed1979

Cholelithiasis and biliary tract disease in sickle-cell disease in Nigerians.

The incidence of biliary tract disease was investigated by oral cholecystography and/or intravenous cholangiography in 77 unselected Nigerians with homozygous sickle-cell disease (SCD). They included 32 males and 45 females with ages ranging from 8 to 31 years. The prevalence of cholelithiasis was 9% with equal sex incidence. The stones were always multiple and 71.4% of them were radio opaque. Visualization and contractility of all gall bladders examined were normal. The only patient with symptoms and signs which suggested biliary tract disease had no radiographic evidence of cholelithiasis and it was impossible to predict the presence of cholelithiasis from the incidence of abdominal crises in the patients. The prevalence of cholelithiasis is significantly less than that reported in American patients with SCD (35%) and different dietary habits are probably responsible for this.

Adolescent↗

PubMed1990

High incidence of cholelithiasis in older patients with homozygous beta-thalassemia.

The records of 48 patients with homozygous beta-thalassemia were reviewed for evidence of cholelithiasis by abdominal ultrasonography or plain abdominal X-ray. The presence of cholelithiasis was reported in 25 patients (52%). The incidence increased with age to 83% in patients over 31 years of age. Gallstones were more frequent among patients with beta-thalassemia intermedia and with less blood transfusion requirements. Eleven patients with cholelithiasis (44%) became symptomatic. Eight received operations on an elective or semielective basis. Another patient had incidental cholecystectomy during splenectomy. The preoperative evaluation included abdominal ultrasonography, nucleotide biliary scan and evaluation of the cardiopulmonary status. Due to the longer survival of patients with homozygous beta-thalassemia, the problem of cholelithiasis is becoming more frequent.

Adolescent↗

PubMed2026

Causal effects of cholelithiasis on hepatopancreatobiliary diseases: a multi-cohort Mendelian randomization study.

BACKGROUND: Cholelithiasis is commonly associated with multiple hepatopancreatobiliary diseases, yet whether these relationships reflect causal mechanisms or shared risk factors remains unclear. METHODS: We performed a phenome-oriented two-sample Mendelian randomization (MR) analysis to evaluate the causal impact of genetic liability to cholelithiasis across hepatopancreatobiliary outcomes. Independent genome-wide significant variants were selected as instrumental variables. Primary analyses used inverse variance weighting, complemented by sensitivity analyses, reverse MR, and multivariable MR adjusting for body mass index (BMI). RESULTS: Genetic predisposition to cholelithiasis was associated with increased risk of acute pancreatitis and extrahepatic cholangiocarcinoma (eCCA), with consistent directionality across datasets.The association with acute pancreatitis was interpreted as a positive control, whereas the null association with alcohol-induced acute pancreatitis served as a negative control. No causal association was observed for portal vein thrombosis. Sensitivity analyses, including MR-PRESSO and MR Steiger filtering, supported the robustness and directionality of the causal estimates. Reverse MR analyses showed no consistent evidence supporting reverse causality. Multivariable MR indicated that observed effects were not fully explained by BMI-related pathways. CONCLUSION: These findings suggest that cholelithiasis susceptibility may contribute to the broader hepatopancreatobiliary disease network, extending its clinical relevance beyond a localized biliary disorder.

Mendelian Randomization Analysis↗

PubMed2003

The influence of local active warming on pain relief of patients with cholelithiasis during rescue transport.

UNLABELLED: Upper abdominal pain, a frequent symptom of the presence of gallstone disease, is the cause of 6% of the emergency calls of the Austrian emergency system. Pain resulting from cholelithiasis is characteristically severe. Recent data show that active warming during emergency transport of trauma victims is effective in reducing pain. Therefore, we hypothesized that local active warming of the abdomen would be an effective pain treatment for patients with acute cholelithiasis and could be provided by paramedics. Sixty patients (>19 yr) consented to participate in this study. They were divided into two groups: Group 1, who received active warming of the upper abdomen with a carbon-fiber warming blanket (42 degrees C), and Group 2, who received no warming of the abdomen. Neither group received any drug-based pain care. Patients were asked to rate their pain and anxiety by using visual analog scales (VAS). Statistical evaluation was performed with Student's t-test; P < 0.05 was considered significant. In Group 1, a significant (P < 0.01) pain reduction was recorded in all cases on a visual analog scale (VAS), from 86.8 +/- 5.5 mm to 41.2 +/- 16.2 mm. In Group 2, the patients' pain scores remained comparable, from 88.3 +/- 9.9 mm to 88.1 +/- 10.0 mm on a VAS. In comparing Group 1 with Group 2 on arrival at the hospital, pain scores showed a significant difference (P < 0.01). In Group 1, the VAS score changes for anxiety were significantly reduced (P < 0.01), from 82.7 +/- 10.8 mm before treatment to 39.0 +/- 14.0 mm after treatment. In Group 2, a nonsignificant change of this score was noted, from 84.5 +/- 14.6 mm to 83.5 +/- 8.4 mm. Comparing Group 1 with Group 2 on arrival at the hospital showed a significant difference in anxiety scores (P < 0.01). We conclude that local active warming is an effective and easy-to-learn treatment for pain resulting from acute cholelithiasis in emergency care. IMPLICATIONS: Active local warming of the upper abdomen is an effective treatment for patients with cholelithiasis being transported to the hospital by paramedics who are not permitted to provide any drug-based pain care. We observed no negative side effects of this treatment.

Abdomen↗

PubMed2006

Clinical and laboratory indices of cholelithiasis in adult Nigerians with sickle-cell anaemia.

The clinical and laboratory indices of cholelithiasis in adult Nigerians with homozygous sickle-cell disease (SCD) were studied in 100 consecutive patients attending the adult SS clinic of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The study examined the role of clinical (sickle cell (SS) crises, body mass indices [BMIs]), haematological (reticulocyte count, haemoglobin) and biochemical (serum bilirubin, serum alkaline phosphatase and serum amino transaminases) indices in predicting the likelihood of finding cholelithiasis in patients with SS anaemia. A positive correlation was found between the BMI, SS crises, reticulocyte count, serum bilirubin, serum alanine and asparate transferases on one hand and the development of cholelithiasis (at P values of 0.04, 0.03, 0.05, 0.01 and 0.04, respectively) on the other. No such association was found between the other indices studied and cholelithiasis.

Adolescent↗

PubMed2003

Polymorphism in transmembrane region of MICA gene and cholelithiasis.

AIM: To study the significance of polymorphism of MHC class I chain-related gene A (MICA) gene in patients with cholelithiasis. METHODS: Subjects included 170 unrelated adults (83 males) with cholelithiasis and 245 randomly selected unrelated adults (130 males) as controls. DNA was extracted from peripheral leukocytes and analyzed for polymorphism of 5 alleles (A4, A5, A5.1, A6 and A9) of the MICA gene. RESULTS: There was no significant difference in phenotype, allele, and genotype frequencies of any of the 5 alleles between cholelithiasis patients and controls. CONCLUSION: This study demonstrates that MICA alleles studied bear no relation to cholelithiasis.

Asian People↗

PubMed2004

Non-complicated cholelithiasis associated with GERD. Results of combined laparoscopic surgery in low risk patients.

BACKGROUND: the aim of this study was to evaluate the efficacy of combined laparoscopic surgery for non-complicated cholelithiasis and gastroesophageal reflux disease (GERD) in patients with low surgical risk. METHODS: a total of 680 cholecystectomies performed by means of laparoscopic surgery were retrospectively studied from February 1991 to February 2002. A total of 442 patients that fulfilled the inclusion criteria were divided into two groups: group A: non-complicated cholelithiasis (cholecystectomy alone), consisting of a total of 362 patients, and group B: non-complicated cholelithiasis and GERD (cholecystectomy and Toupet's fundoplication in all cases) in 80 patients. Demographic and clinical data, intraoperatory incidences, and post-surgical complications were prospectively collected and compared for all patients. The results of reflux surgery (group B) were evaluated at 6 months by means of 24-hour pH-metry. RESULTS: in spite of the fact that the group undergoing combined surgery consisted of patients with greater weight and older age (p < 0.05), no significant differences were found in the number of intraoperative incidences and post-surgical complications between both groups (NS). Significant differences were only found in the duration of surgery: 48 +/- 25 min (10-150) in group A compared to 112 +/- 23 min (80-180) in group B (p<0.001), and in the return to normal daily activities (5.8 +/- 0.9 days vs 6.5 +/- 1 days in group B) (p< 0.001). In the latter group a normalization of 24-hour pH-metry values and an absence of symptoms associated with reflux were observed in all cases. CONCLUSIONS: in patients younger than 75 years with low surgical risk and non-complicated cholelithiasis and GERD, both illnesses can be resolved during the same surgical procedure by laparoscopy with no increased risk or postoperative complications.

Adult↗

PubMedDate not supplied

Comparison of real-time and static-mode gray-scale ultrasonography in the diagnosis of cholelithiasis.

Real-time and conventional articulated-arm gray-scale static-mode scanning were performed on 100 patients in a prospective study to determine the complementary or duplicative roles of these two ultrasound modalities in the confirmation of clinically suspected cholelithiasis. Twenty-five abnormal findings were documented ultrasonographically, including 21 cases of cholelithiasis (12 confirmed by oral cholecystography and/or surgery), two cases of biliary sludge, one case of a gallbladder polyp, and one case of a probable blood clot. There was no instance of gallbladder lumen nonvisualization. Except in one case (that of a 420-pound patient), real-time ultrasonography documented all the gallbladder abnormalities shown by the articulated-arm static scans. In two cases, one corroborated by oral cholecystography, cholelithiasis was documented by real-time and not by static-mode ultrasonography. In most cases, real-time ultrasonography can be used to document the presence of cholelithiasis and obviate the need for conventional articulated-arm static-mode scanning.

Cholecystography↗

PubMed1976

Atherosclerosis in relation to cholelithiasis and cholesterolosis.

The frequency of cholelithiasis and cholesterolosis was remarkably similar in Prague and Malmö subjects. When the possible effects of associated hypertension or diabetes mellitus were taken into account, subjects with cholelithiasis showed the same extent of raised and calcified lesions of the coronary arteries, the same prevalence of large myocardial scars, and the same distribution of heart weight as subjects without cholelithiasis. In general, they showed rather fewer raised and calcified lesions of the aorta, less coronary stenosis, and fewer fresh myocardial infarctions than subjects without cholelithiasis. Subjects with cholesterolosis were similar to those without this condition in respect of raised lesions of the aorta and coronary arteries. Men with cholesterolosis had slightly more aortic calcification and slightly less coronary calcification. Women with cholesterolosis had slightly less coronary stenosis than those without cholesterolosis. There was a slight tendency for those with cholesterolosis to show an increased frequency of fresh myocardial infarction and large myocardial scars and to have a higher heart weight.

Adolescent↗

PubMed2001

[Minimally invasive treatment of cholelithiasis in the elderly].

BACKGROUND: As cholelithiasis has an incidence which is proportional to the age of the patient, it is often detected in the elderly, who have a higher operative risk. Therefore the therapeutic approach should involve low risk and low invasive techniques. The aim of this study is to evaluate the efficacy of combined laparoscopic and endoscopic treatment in biliary tract lithiasis and gallstones. METHODS: One hundred and fifty-seven patients over 60 years old affected by cholelithiasis have been treated with minimally invasive techniques. Mean age was 68+/-5.9 years (range 60-85) and male/female ratio was 1:1.5. All the patients underwent a preoperative screening (abdominal ultrasound, liver functional tests) to evaluate the risk of choledocholithiasis associated to cholelithiasis. An ultrasound examination was performed postoperatively after 15 days and then after 6 months. RESULTS: No death due to cholecystectomy or endoscopic sphincterotomy was registered, while morbility was 5.7%. Mean hospital stay was 2+/-1.67 days which reached 5.3+/-0.7 days in case of endoscopic sphincterotomy with ERCP. CONCLUSIONS: Cholecystectomy and endoscopic sphincterotomy revealed to be low risk techniques and therefore they will to become the gold-standard treatment of cholelithiasis in the elderly.

Age Factors↗

PubMed2001

[Composition and role of short chain fatty acids in feces and peripheral blood serum of patients with cholelithiasis].

Gas-liquid chromatography was used to estimate content of short-chain fatty acids (SCFA) in 25 patients with cholelithiasis, 32 patients with irritable colon syndrome and constipation (ICS) and 35 healthy subjects. It was found that SCFA absolute and relative concentration in the feces of cholelithiasis patients is abnormal indicating disturbance of microbiocenosis as shown by changes in functional activity of some anaerobes of the intestinal microflora participating in enterohepatic circulation of bile acids. Alterations of SCFA content in the serum of cholelithiasis patients may be related to steroids disbolism. The study of SCFA in the feces and peripheral blood serum from cholelithiasis patients is of diagnostic value.

Cholelithiasis↗

PubMed1992

Cholelithiasis in infants receiving furosemide: a prospective study of the incidence and one-year follow-up.

Cholelithiasis has been reported to occur rarely in infants. To determine the incidence of cholelithiasis in infants receiving furosemide, we prospectively performed ultrasonograms on 86 patients. We studied 42 patients receiving furosemide (subjects) and 44 patients not receiving furosemide (controls). There was a significantly higher incidence of gallstones in subjects (21%) than in controls (2%) (P less than .05). When followed over 1 year, the gallstones did not resolve. There were no significant differences in the dosage of furosemide, gestational age, placement of umbilical venous catheters, or amount of total parenteral nutrition (TPN) between subjects with and without gallstones. However, subjects received more days of TPN (16.7 +/- 15.1) than controls (8.4 +/- 13.2) (P less than .05). These data show that the incidence of cholelithiasis is higher than previously suspected in infants receiving furosemide. Thus, furosemide, either independently or in conjunction with the use of TPN, predisposes infants to the development of cholelithiasis.

Bronchopulmonary Dysplasia↗

PubMed1992

[Celioscopic cholecystectomy in simple and complicated cholelithiasis. Apropos of 392 cases].

In a study including 392 patients we compared two groups of patients according to the indication for laparoscopic cholecystectomy: group I: 293 patients treated for simple cholelithiasis (n = 291) or gallbladder polyps (n = 2). Group II: 99 patients operated for complicated cholelithiasis. For each patient, 14 pre, intra and postoperative parameters were analysed and compared. Mean operative time was 80 minutes. Primary and secondary laparotomies were necessary in 5.8% and 1.3% of cases respectively. Biliary injury was the most frequent complication (1.3%). Mean hospital stay was 4.5 days. In terms of mean age, operative time, intraoperative incidents and complications, and primary laparotomy. There was a significant difference between the two groups (p less than 0.001). There were 4 secondary laparotomies in group II and one in group I. These results suggests that laparoscopic cholecystectomy is a safe technique with a low mortality rate (0.25%). The comparative study proves that this technique, first indicated for simple cholelithiasis, is also applicable to the majority of complicated cholelithiasis.

Acute Disease↗

PubMed1992

[Role of cholestanol in the pathogenesis of cholesterol cholelithiasis].

The proportion of cholestanol/cholesterol in hepatic and cystic bile was evaluated using capillary gas-chromatography in subjects with disturbances in the biliary system (biliary dyskinesia, chronic acalculous cholecystitis, chronic calculous cholecystitis). The proportion was also measured in bile "paste" and cholesterol choleliths. With progression of cholesterol cholelithiasis, the proportion cholestanol/cholesterol increases, reaching its maximum in the stone the center of which accumulates crystals of cholestanol-cholesterol dihydrate. An original conception is proposed on pathogenesis of cholesterol cholelithiasis in man. It considers cholestanol as factor-reason underlying various pathological processes running in cholesterol cholelithiasis. Cholestanol is suggested to mark cholesterol cholelithiasis.

Bile↗

PubMed2005

[Immediate and long-term effects of endoscopic papillosphincterotomy in patients with cholelithiasis].

The subjects of the study were 164 patients, divided into two groups. Group I included 76 patients at the physicochemical stage of cholelithiasis, and 38 patients after cholecystectomy, who underwent endoscopic papillosphincterotomy (EPST). Group II (control) included 30 patients at the physicochemical stage of cholelithiasis, and 20 patients after cholecystectomy, who did not undergo EPST. Endoscopic retrograde pancreatocholangiography revealed type II Oddi's sphincter dysfunction in all the patients. Evaluation of the chemical composition of bile in Group I, performed 6, 12, 18, and 24 months after EPST, revealed its graduate stabilization. In Group II the dynamics of bile composition was negative--in 8 patients bile became more lithogenic. Long-term observations showed that 6 years after EPST bile was lithogenic only in 4 Group I patients, while at the same moment in 25 Group I patients bile lithogenicity did not disappear, but even worsened. Biliferous tract ultrasonography, performed long after EPST, found biliary sludge in 4 Group I patients. 6-year observation of Group Il patients, including ultrasonography, demonstrated that during the 4th year of observation biliary sludge occurred in as many as 28 patients, in 15 of whom small concrements on the bottom of the gall bladder were found during the 5-6th year of observation, and in 3 of whom a solitary concrement of 4 to 5 mm in diameter was found in the choledoch. The results demonstrate that it is appropriate to perform EPST as early as at the physicochemical stage of cholelithiasis, because this procedure results in stabilization of biliary colloid balance and thus prevents biliary sludge and forming of gall bladder concrements. At the same time, 36% of patients with cholelithiasis at various stages who did not undergo EPST, formed gall bladder concrements. EPST is also appropriate in some patients after cholecystectomy, in order to prevent repeating gall bladder concrement formation.

Cholelithiasis↗