Gallstone Disease In Patients Research Articles

Histologic Findings of Gallbladder Mucosa in 87 Patients With Morbid Obesity Without Gallstones Compared to 87 Control Subjects

Obesity is an important risk factor for the development of gallstones. The purpose of this study was to determine histologic alterations in the gallbladder mucosa and the prevalence of gallstone disease in patients with severe and morbid obesity compared to histologic findings in the gallbladder mucosa of control subjects. Two groups were studied: 125 severely obese patients (38 with and 87 without gallstones) and 87 control subjects. Ultrasonography was performed in all of them before surgery. During surgery, cholecystectomy was performed in 87 obese patients with a “normal” gallbladder and in all 87 control subjects. Specimens were immediately sent for histologic analysis. The prevalence of gallstones was twice as high among obese women compared to obese men ( P < 0.001). Normal gallbladder mucosa was found in 28.7% of obese women compared to 34.2% of control women ( P > 0.59). Findings were similar among the men. The most frequent histologic abnormality in the gallbladder mucosa among obese women was cholesterolosis (37%), followed by chronic cholecystitis and cholesterolosis (18%), with frequencies of 23% and 12%, respectively, in control women ( P > 0.1). Among men, a similar proportion of histologic abnormalities was seen in obese men and control subjects. In our population of obese patients compared to control subjects, a similarly high proportion of histologic abnormalities of the gallbladder mucosa was found in the absence of stones. These findings could have been attributed to the fact that the Chilean population has a high incidence of gallstones. ( J Gastrointest Surg 2003;7:547–551).

Prevalence of gallstone disease in patients with end stage renal disease treated with hemodialysis

Prevalence of gallstone disease in patients with end stage renal disease treated with hemodialysis

Symptomatic gallstones in patients with spinal cord injury

Patients with spinal cord injury (SCI) have an increased prevalence of cholelithiasis. The goal of this study was to clarify the presentation and management of symptomatic gallstone disease in patients with SCI. We performed a retrospective study of presentation of gallstone complications in patients with SCI who underwent cholecystectomy for complications of gallstone disease. The West Roxbury Veterans Administration Medical Center SCI registry (605 patients) was searched for patients who had undergone cholecystectomy more than 1 year after SCI (35 patients). Gallbladder disease profiles for the 35 patients undergoing cholecystectomy for complications of gallstone disease were prepared, including demographics, clinical presentation, diagnostic studies, operative and pathologic findings, and postoperative complications. All patients were white. Thirty-four were male and the mean age was 50 years (range 35 to 65 years). The majority of patients (66%) complained of right upper quadrant abdominal pain, even those patients with SCI at high (i.e., cervical) levels. Of the 35 patients in our study group, 22 (63%) had biliary colic and chronic cholecystitis, nine (26%) had acute cholecystitis (gangrenous cholecystitis in two), two (6%) had choledocholithiasis symptoms or cholangitis, and two (6%) had gallstone pancreatitis. Major perioperative morbidity occurred in two (6%) of the 35 patients (pulmonary embolus; intraoperative hemorrhage), and there were no deaths. In the great majority of patients with SCI, cholelithiasis presents with chronic pain and not with life-threatening complications. Our findings suggest that presentation is no more acute in patients with SCI than in the general population. Characteristic symptoms and signs are not necessarily obscured by SCI injury, regardless of the level.

Laparoscopic cholecystectomy and cirrhosis:a case-control study of outcomes

The incidence of gallstone disease in patients with cirrhosis is greater than that in healthy patients. Previous surgical literature reported greater morbidity and mortality in patients with cirrhosis with both open and laparoscopic cholecystectomy (LC). We compared our recent experience with LC in patients with cirrhosis and controls. A retrospective review was performed using the search terms, “cirrhosis” and “laparoscopic cholecystectoaiy” Forty-eight patients with cirrhosis were identified and randomly matched with healthy controls by age and sex. Four controls were assigned per patient with cirrhosis. Outcomes assessed included mortality, duration of surgery, length of hospital stay, blood transfusion requirement, postoperative complications, and need for conversion to open cholecystectomy. Forty-eight patients with cirrhosis and 187 healthy controls underwent LC. Child-Pugh classification of severity of liver disease was as follows: Child's class A, 38 of 48 patients; Child's class B, 10 of 48 patients; and Child's class C, 0 of 48 patients. Patients with cirrhosis had statistically significantly lower albumin levels ( P = .0001) and prolonged prothrombin times ( P = .05). Average duration of surgery for patients with cirrhosis was 1.71 versus 1.57 hours ( P = .57) for controls. Average length of hospital stay for patients with cirrhosis was 6.47 versus 4.77 days ( P = .152) for controls. Average number of units of blood transfused in patients with cirrhosis was 0.156 versus 0.0 units ( P = .025) in controls. Complications occurred in 6 of 48 patients with cirrhosis (12.5%) and 8 of 187 controls (4.2%; P < .05). No child's class C patient underwent LC. Four patients with cirrhosis (8.3%) and no controls were converted to open cholecystectomy. No postoperative infections were noted. There was no mortality in either group. LC in patients with Child's class A and B cirrhosis is reasonably safe and shows no increase in morbidity or mortality or worsening of outcome. Further studies are required to evaluate the management of acute gallbladder disease in Child's class C patients.

Functional Gastrointestinal Disorders and Eating Disorders: Relevance of the Association in Clinical Management

Background: As functional gastrointestinal disorders (FGID) are common in eating disorder patients, we aimed to assess past eating disorders in patients referred for current FGID. Methods: One hundred and twenty-seven consecutive FGID outpatients and 163 patients with gallstone disease (GD) were enrolled. All patients were interviewed to detect GI symptoms (by means of the GI Symptom Rating Scale), lifetime eating disorders (on the basis of DSM-IV criteria), and current psychologic distress (on the Hospital Anxiety and Depression Scale). Results: Past eating disorders were significantly more prevalent in FGID (15.7%) than in GD patients (3.1%) (chi-square = 14.6, P < 0.001). FGID patients with past eating disorders were significantly younger, more educated, more psychologically distressed, more dyspeptic, and more were women than FGID patients without past eating disorders. Conclusions: This study confirms the previously found association between functional GI symptoms and eating disorders and shows that functional GI symptoms may still persist even after the recovery from eating disorders, particularly in psychologically distressed patients.

Prevalence and Incidence of Gallstones in Liver Cirrhosis

Background: Our aim was to assess the prevalence and incidence of gallstone disease in patients with liver cirrhosis and to identify risk factors for cholecystolithiasis. Methods: We studied a cohort of 313 patients with liver cirrhosis confirmed by histology and/or laparoscopy and 357 patients free of liver disease, who had been referred for ultrasonographic examination of the upper abdomen. Hepatobiliary ultrasonography was performed when liver cirrhosis was diagnosed and every 6 months thereafter. Risk factors for cholelithiasis (age, gender, diet, pregnancy, diabetes, family history of cholelithiasis, etiology of cirrhosis, decompensated disease) were assessed. Results: The overall prevalence of gallstones in cirrhotic patients was 23.3%. In controls, the overall prevalence of cholecystolithiasis was 16.8%. After a median follow-up period of 65 months, 30 patients developed gallstones. The calculated annual incidence was 3.4%. Conclusions: Given that the prevalence of gallstone disease is higher in cirrhotics than in noncirrhotic patients, cirrhosis of the liver may be considered a risk factor for cholecystolithiasis.

Somatostatin Inhibits Cholecystokinin-Induced Contraction of Isolated Gallbladder Smooth Muscle Cells

A close relation between the hyperhormonism of somatostatin and gallstone disease suggested to us the hypothesis that somatostatin inhibits cholecystokinin (CCK)-induced gallbladder contraction on the level of target organs. To investigate this hypothesis, smooth muscle cells were isolated from human and canine gallbladders and the direct inhibitory effects of somatostatin on the CCK-induced cell contraction were examined in vitro. Somatostatin alone had no effect on the cell motility, while it significantly inhibit the cholecystokinin-octapeptide (10 -10 M)-induced cell contraction at the concentration of 10 -6 M ( P < 0.01) in both human and canine gallbladders. The results demonstrate for the first time that somatostatin has a direct inhibitory action against cholecystokinin-induced gallbladder contraction. This may partly account for the high frequency of gallstone disease in patients with somatostatinoma.

Laparoscopic cholecystectomy in cirrhotic patients. Indication or contradiction?

Liver cirrhosis is considered a contraindication to laparoscopic cholecystectomy for the moment. Here we are reporting on results in the surgical treatment of gallstone disease in cirrhotic patients by laparoscopic means. We reviewed the experience over the final period of time in 11 patients since the introduction of laparoscopic procedures in our unit. The index of conversion rate was 9.1% (1/11). The morbidity was nil. The average length of hospital stay was 1.8 days (1-6 days). We propose the use of laparoscopic cholecystectomy in gallstone disease in patients with liver cirrhosis as first-line surgical treatment.

Doppler demonstration of cystic vein dilatation secondary to portal vein thrombosis

High-resolution duplex ultrasound was used to demonstrate vascular dilatation in the gallbladder wall in eight patients with portal vein thrombosis. Gallbladder thickening, combined with a higher incidence of gallstone disease in patients with chronic hepatic disease can be misinterpreted as acute cholecystitis. The Doppler is helpful in detecting the vascular cause of the gallbladder wall thickening thus helping to reduce the frequency of inappropriate cholecystectomy.

Gallstone Disease in Patients with Severe Short Bowel Syndrome Dependent on Parenteral Nutrition

An increased incidence of gallbladder disease is seen in patients receiving long-term parenteral nutrition (PN). Stasis is thought to play a key role in the development of gallbladder sludge and gallstone formation. The highest incidence of gallbladder disease, by previous reports, is seen in patients with terminal ileal disease or resection. Since PN-dependent patients with severe short bowel syndrome secondary to mesenteric vascular accident have both gallbladder stasis and massive small bowel resection, a retrospective study was undertaken to evaluate the incidence of symptomatic gallbladder disease in this group. Of 11 patients followed over 9 years, five met the inclusion criteria of less than 60 cm of bowel remaining, receiving PN for longer than 6 months and the initial presence of a gallbladder. All five patients developed symptomatic gallbladder disease manifested by cholecystitis or pancreatitis. Factors contributing to gallbladder stasis included poor oral intake and use of anticholinergic and analgesic drugs. Gastric hypersecretion indirectly contributed to decreased oral intake as a means to minimize stool output. As these patients often require several laparotomies during the initial hospitalization, consideration should be given to performing prophylactic cholecystectomy, especially when the potential mortality and morbidity of emergent cholecystectomy done for symptomatic gallbladder disease is taken into account.

Biliary lipid composition in patients with cystic fibrosis.

Lipid composition of gallbladder bile was determined in 20 patients with cystic fibrosis (CF) (9 females and 11 males, ranging in age from 3 to 18 years). The results were compared with 47 normal subjects matched for age, sex, and pubertal stage. In patients with CF, bile was undersaturated with cholesterol before puberty in both sexes and no differences with normal controls could be observed. After puberty, a similar increase in cholesterol saturation was noted in females with CF (85 +/- 15% vs. 130 +/- 38%, p less than 0.01) and normal controls (82 +/- 11% vs. 138 +/- 31%, p less than 0.01). No change in cholesterol saturation could be observed in male patients and controls after puberty. Molar percentage of chenodeoxycholic acid (CDCA) was lower (p less than 0.05) in postpubertal females (31 +/- 9%) and males (36 +/- 7%) with CF compared to controls (42 +/- 8% and 40 +/- 5%, respectively), while cholic acid (CA) was higher in all patients with CF. In females with CF, lithocholic acid (LCA) increased after puberty (2.2 +/- 0.8% vs. 5.3 +/- 2.6%, p less than 0.05) and was higher compared to controls (2.2 +/- 0.8%, p less than 0.001). An increase was also noted for deoxycholic acid (DCA) in postpubertal females with CF (1.7 +/- 2.6% vs. 10.8 +/- 7%, p less than 0.05), but it was lower in both sexes after puberty than in respective controls. The present results suggest that cholesterol saturation of bile in patients with CF is not different from respective controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Biliary Lipid Composition in Patients with Cystic Fibrosis

SUMMARYLipid composition of gallbladder bile was determined in 20 patients with cystic fibrosis (CF) (9 females and 11 males, ranging in age from 3 to 18 years). The results were compared with 47 normal subjects matched for age, sex, and pubertal stage. In patients with CF, bile was undersaturated with cholesterol before puberty in both sexes and no differences with normal controls could be observed. After puberty, a similar increase in cholesterol saturation was noted in females with CF (85 ± 15% vs. 130 ± 38%, p &lt; 0.01) and normal controls (82 ± 11% vs. 138 ± 31%, p &lt; 0.01). No change in cholesterol saturation could be observed in male patients and controls after puberty. Molar percentage of chenodeoxy‐cholic acid (CDCA) was lower (p &lt; 0.05) in postpubertal females (31 ± 9%) and males (36 ± 7%) with CF compared to controls (42 ± 8% and 40 ± 5%, respectively), while cholic acid (CA) was higher in all patients with CF. In females with CF, lithocholic acid (LCA) increased after puberty (2.2 ± 0.8% vs. 5.3 ± 2.6%, p &lt; 0.05) and was higher compared to controls (2.2 ± 0.8%, p &lt; 0.001). An increase was also noted for deoxycholic acid (DCA) in postpubertal females with CF (1.7 ± 2.6% vs. 10.8 ± 7%, p &lt; 0.05), but it was lower in both sexes after puberty than in respective controls. The present results suggest that cholesterol saturation of bile in patients with CF is not different from respective controls. Thus, the higher incidence of gallstone disease in patients with CF reported in the literature might be related to other hepato‐biliary disorders known in this disease.

Beta-Glucuronidase Activity in the Bile of Gallstone Patients Both with and without Duodenal Diverticula

Patients with juxtapapillary duodenal diverticula have an increased occurrence of calcium bilirubinate gallstones. One possible hypothesis to explain this observation is enzymatic deconjugation of bilirubin conjugates in the bile. Beta-glucuronidase of human or bacterial origin may lead to deconjugation of the bilirubin glucuronides in bile. This, in turn, may increase the amounts of unconjugated, water-insoluble bilirubin which can precipitate as calcium bilirubinate, the main component of brown pigment stones. In this study we compared gallstone patients with and without duodenal diverticula treated with endoscopic papillotomy. Increased occurrence of bacteria producing beta-glucuronidase (p less than 0.01) and increased activity of bacterial beta-glucuronidase (pH 7.0) in the bile itself (p less than 0.01) were found in patients with duodenal diverticula. When the activity of the enzyme at pH 4.5, the optimum of the human enzyme, was measured, no such difference was found. The results support the hypothesis of bacterial glucuronidase as an etiologic factor in pigment gallstone disease in patients with duodenal diverticula. The high activity of bacterial enzyme found in the bile in some patients without diverticula suggests bacteria as an etiologic factor, independent of the presence of diverticula.

Biliary lipid composition in normo- and hyperlipoproteinemia

The lipid composition of fasting gallbladder bile obtained under standardized conditions was determined in healthy controls and in patients with hyperlipoproteinemia without gallstones. Altogether 23 normolipidemic controls (10 males and 13 females) and 50 hyperlipidemic patients (31 type IIa, 7 type IIb, and 12 type IV) were studied; all were less than 15% overweight. The cholesterol saturation averaged 96 ± 5% (mean ± SEM) in the controls, and 10 of them had bile supersaturated with cholesterol. There was no difference between males and females. An increased saturation with age was seen in females. A normal biliary cholesterol saturation (102 ± 3%) was found in patients with hyperlipoproteinemia type IIa; this was true also for the subgroup with established familial hypercholesterolemia. All patients with hyperlipoproteinemia type IIb and 10 of those with type IV had saturated bile (135 ± 8% and 121 ± 6%, respectively). The results suggest an association between certain forms of hyperlipoproteinemia and the development of supersaturated bile. Since fasting gallbladder bile supersaturated with cholesterol is considered to precede gallstone formation, the present results may explain previous findings of an increased prevalence of gallstone disease in patients with hypertriglyceridemia.

The natural course of gallstone disease

Summary This paper is concerned with the natural history of gallstone disease in patients with diagnosed, but not surgically treated, gallstones. The material comprises all 1501 patients from the city of Malmo in whom cholecystography in 1951 or 1952 revealed either gallstones or nonfilling of the gall bladder. Of these, 781 were not operated upon and did not have complications within 1 year of the roentgen examination. These 781 patients were followed for 11 years. At least 35% developed complications (severe cholecystitis; icterus or pancreatitis or both; ileus; cancer), or such severe symptoms that elective cholecystectomy eventually was performed.