Pigment Gallstones Research Articles

Integration of bile proteomics and metabolomics analyses reveals novel insights into different types of gallstones in a high-altitude area

BackgroundTo explore the pathogenesis of different subtypes of gallstones in high-altitude populations from a molecular perspective.MethodsWe collected bile samples from 20 cholesterol gallstone disease (CGD) patients and 20 pigment gallstone disease (PGD) patients. Proteomics analysis was performed by LC/MS DIA, while metabolomics analysis was performed by UPLC- Q-TOF/MS.ResultsWe identified 154 up-regulated and 196 down-regulated differentially expressed proteins, which were significantly enriched in neurodegenerative diseases, energy metabolism, amino acid metabolism etc. In metabolomics analysis, 20 up-regulated and 63 down-regulated differentially expressed metabolites were identified, and they were significantly enriched in vitamin B6 metabolism. Three pathways of integrated proteomics and metabolomics were significantly enriched: porphyrin and chlorophyll metabolism, riboflavin metabolism and aminoacyl-tRNA biosynthesis. Remarkably, 7 differentially expressed proteins and metabolites showed excellent predictive performance and were selected as potential biomarkers.ConclusionThe findings of our metabolomics and proteomics analyses help to elucidate the underlying mechanisms of gallstone formation in high-altitude populations.

Chromatographic analysis of the amino acid composition of gallstones

Gallstone disease (cholelithiasis) is a multifactorial disease characterised by the formation of gallstones. Studying the composition of gallstones is necessary to understand the mechanism of their formation and to solve many practical issues. At present, it is not clear which protein component is involved in the formation of gallstones and how it is related to their components. The study showed the possibility of qualitative and quantitative determination of amino acids in the composition of gallstones of men and women of different ages using a GC-17A gas chromatograph (Shimadzu). Analysis of the amino acid composition of gallstones includes acid hydrolysis of samples with 6M HCl at 105C° for 12 hours, subsequent purification, obtaining derivatives of isolated amino acids, and their determination by gas chromatography. This technique enables the determination of D- and L-forms of amino acids. Statistical processing of the obtained data was carried out using Statistica 6.0. The study revealed that cholesterol gallstones belonging to women up to 50 years of age have the lowest amino acid content. The amino acid composition of cholesterol gallstones is dominated by glycine and L-forms of serine, alanine, and glutamic acid. Cholesterol gallstones with mineral content are typical for elderly women (over 60 years) and middle-aged men (from 37 years), and have higher amino acid content than cholesterol gallstones. Glycine and the L-forms of leucine, glutamic acid, and asparagic acid are prevalent in these types of gallstones. The highest amino acid content was recorded in pigment gallstones of both men and women over 55 years of age. The amino acid composition of pigment gallstones is dominated by glycine and L-forms of glutamic acid, asparagic acid, leucine, and alanine. In cholesterol gallstones, no D-amino acids were found. In cholesterol gallstones with mineral content and pigmented gallstones, D-aspartic acid was detected. The obtained results allow us to recommend the method of gas chromatography for studying the amino acid composition of gallstones.

Comparative Sonographic Evaluation of the Gallbladder in Sickle Cell Disease Patients and Apparently Healthy Non-Sickle Cell Disease Individuals in a Nigerian Town

Background: Sickle cell disease (SCD) is an autosomal recessive blood disorder with multi-organ manifestations including the gall bladder. Studies have shown that individuals with sickle cell disease have strong tendency of developing pigment gallstones due to chronic red blood cell hemolysis and increased bilirubin levels.
 Aim and Objectives: The aim of this study was to evaluate and compare the gallbladder changes which includes volume, wall thickness, presence of biliary sludge and prevalence of calculi between age and sex-matched sickle cell disease patients and apparently healthy, normal non-SCD individuals.
 Materials and Methods: This was a cross-sectional comparative study of 50 known SCD patients attending the Haematology clinic of sub-urban tertiary health facility in Nigeria, and equal number of age and sex-matched apparently healthy, non-SCD volunteers attending the Well people clinic of the same hospital as controls. Each subject was evaluated for gallbladder volume, wall thickness, presence of biliary sludge and gallstones using a 3.5-5MHz curvilinear array transducer of a Mindray ultrasound machine, DC-6 model, 2016.
 Data Analysis: The data collected was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 21.
 Statistical test was considered significant at p-value ≤ 0.05 and a confidence interval of 95%.
 Results: Out of the 100 subjects who underwent scanning, 50 were patients with sickle cell disease, consisting of 29 males (58.0%) and 21 females (42.0%), while the remaining 50 were non-sickle cell disease volunteers serving as controls, comprising 24 males (48.0%) and 26 females (52.0%). Their ages ranged from 2 to 65 years.
 The mean age of the cases and controls was 22.1±14.7 years and 19.9±12.6 years respectively. Among the patients; 8 (16.0%) had cholecystitis and 10 (20.0%) had gallstones, with no detectable abnormality in the controls.
 Conclusion: The ultrasonographic prevalence of gallbladder abnormalities was recorded only in patients with sickle cell disease when compared to apparently healthy controls as shown with increased prevalence with age.

Laparoscopic cholecystectomy for symptomatic cholelithiasis in children and adolescents: analysis of 50 cases from a single institution.

To investigate the clinical characteristics of symptomatic cholecystolithiasis and laparoscopic cholecystectomy complications in pediatric patients. The medical records of 50 children and adolescents who underwent laparoscopic cholecystectomy were analyzed. We evaluated gender, age, body mass index, preoperative clinical aspects, perioperative complications, and gallstone composition. Among the patients, 33 (66%) were female, and 17 (34%) were male. The mean age was 11.4 ± 3.6. All patients were diagnosed with cholecystolithiasis by abdominal ultrasonography. Twelve patients (24%) had hematological disease: eight (16%) with sickle cell anemia and four (8%) with hereditary spherocytosis. Thirteen patients (26%) were obese. Twelve patients (24%) had complicated biliary disease. During the intraoperative period, three patients (6%) had excessive bleeding in the hepatic hilum, and one had an accidental injury to the common bile duct. Three (6%) postoperative complications (acute pancreatitis, common bile duct stenosis, and intestinal obstruction) were observed. Among 28 patients (56%), 25 (50%) had cholesterol gallstones, and three (6%) had bile pigment gallstones. The evolution of cholecystolithiasis in the pediatric population can present serious complications, emphasizing the need to avoid temporizing cholecystolithiasis in children and adolescents because laparoscopic cholecystectomy in this group is safe, with low complication rates.

Quantitative phase analysis and molecular structure of human gallstones using synchrotron radiation X-ray diffraction and FTIR spectroscopy

Human gallstones are the most common disorder in the biliary system, affecting up to 20 % of the adult population. The formation of gallstones is primarily due to the supersaturating of cholesterol in bile. In order to comprehend gallstone disease in detail, it is necessary to have accurate information about phase identification and molecular structure. Different types of gallstone samples were collected from the Middle East area after surgical operations including; cholesterol, pigment, and mixed gallstones. To estimate the basic information about the stone formation and the pathophysiology of cholelithiasis as well as to classify the collected human gallstones, attenuated total reflection Fourier transform Infrared spectrometry (ATR-FTIR) was used to analyze the different gallstone structures in the wavenumber range from 400 to 4000 cm−1. Calcium bilirubinate was specified by the bands at 1662 cm−1, 1626 cm−1, and 1572 cm−1, while cholesterol rings were designated by the bands at 1464, 1438, 1055, and 1022 cm−1. It can be assumed that all samples consist of mixed gallstones based on the doublets at 1375 cm−1 and 1365 cm−1. The levels of calcium bilirubin and various minerals varied among the analyzed samples, indicating the heterogeneity in their composition and suggesting potential implications for gallstone formation. Based on the quantitative phase analysis using synchrotron radiation X-ray diffraction (SR-XRD), two phases of anhydrous cholesterol as a major content and one phase of monohydrate cholesterols as trace content represent the main components of most of the gallstones. Additional phases of calcium carbonate in the form of calcite, vaterite, aragonite, and bilirubinate were also quantified. According to the outcomes of the FTIR and the SR-XRD measurements, there exists a statistical correlation between the different types of chemical constituents of the gallstones.

Пигментные холелиты

The study of the processes and products of biomineral formation in various organs and tissues is of general scientific interest for solving practical issues related to the physiological functioning of living organisms. 
 The object of the study was multiple pigment gallstones removed from the gallbladder in people living in the Komi Republic. The purpose of the work was a comprehensive study of the composition and structure of pigment gallstones, as well as a comparative analysis of the studied samples with natural organic carbon-containing mineraloids. 
 The following methods were used during the study methods: X-ray diffraction (Shimadzu XRD-6000), IR-spectroscopic (InfraLum FT-02), thermal (TGA/DSC 3+), mass spectrometry (Elan-6100), chemical (EA-1110), atomic emission (Optima-4300 DV). The cleavages of the samples were studied by a scanning electron microscope with an X-Max energy-dispersive attachment (VEGA3 TESCAN) and atomic force microscope (Ntegra Prima (NT-MDT)).
 As a result of the studies, it was established that pigment gallstones contained an amorphous organic and mineral component - calcium bilirubinate, calcium carbonate (calcite, aragonite), calcium phosphate (magnesium-containing hydroxylapatite). Thermal-oxidative destruction of samples occured in the high-temperature region (500 ºC and above). Pigment gallstones belonged to formations with low carbon content. Microminerals in the samples were represented by classes of oxides, chlorides, silicates, carbonates and oxalates. Detailed studies of the nanostructure of pigment gallstones showed that it was represented by globule-like particles, the size and order of which varies. We newly revealed that pigment gallstones, according to a number of criteria, were similar to natural organic carbon-containing mineraloids.

Elemental studies and mapping of cholesterol and pigment gallstones using scanning electron microscopy–energy dispersive spectroscopy

AbstractGallstone formation is one of the most severe human diseases, with regional differences in gallstone composition worldwide. The formation of gallstones inside the gallbladder is a complex process and is still under debate despite advances in instrumentation. This study was an in‐depth analysis of the chemical, structural, and elemental composition of cholesterol and pigment‐type gallstones using Fourier transform infrared (FTIR) spectroscopy and scanning electron microscopy–energy dispersive X‐ray spectroscopy (SEM–EDS). Thermal gravimetric and differential scanning calorimetry (TG‐DSC) analysis was also carried out on gallstones to predict their thermal behavior. FTIR spectroscopy was employed to distinguish the cholesterol and pigment gallstones. Using SEM, we performed the morphological studies of gallstone and EDS were carried out to analyze elemental distribution within the gallstones. Elemental imaging and mapping of the major and minor elements within the cholesterol and black pigment gallstones were carried out, revealing the stone's heterogeneous nature. The level of heavy and toxic elements was found to be higher in pigment stones than in cholesterol gallstones. The results obtained from TG‐DSC are well correlated and supported by the results from FTIR spectroscopy.

In-vitro Dissolution Study of Gallstone with Medicinal Plant Extracts

Background: Gallstone disease poses a substantial economic burden on healthcare systems globally, necessitating safer alternatives to current treatments like dissolution therapy and cholecystectomy. Natural compounds from plants offer a potential solution, but research on their cholelitholytic activity is limited. In vitro dissolution studies are crucial for identifying effective plant-based therapies. Objective: This study aims to investigate the in vitro cholelitholytic activity of six plants and Ayurvedic medicines, selected based on ethnopharmacological knowledge and folk medicinal practices. Methods: Gallstone samples were categorized as combined cholesterol gallstones (CCGS) or black pigment gallstones based on external morphology and cross-sectional analysis. In vitro dissolution studies were conducted using extracts from Bergenia ciliata, Berberis asiatica, Cuscuta europaea, Kalanchoe pinnata, Teraxacum officinale, Macrotyloma uniflorum, and Ayurvedic medicines (Cystone®, Gokshuradi, and Calcury). The samples were immersed in the extracts and controls separately and incubated in a shaking water bath. The gallstone dissolution capacity was assessed by recording the dry weight of the samples at multiple time points. Results: T. officinale was highly effective in dissolving black pigment gallstones, while B. asiatica exhibited superior efficacy for CCGS. M. uniflorum and C. europaea also demonstrated significant dissolution activity against black pigment gallstones. However, K. pinnata was less effective for both gallstone types. B. ciliata and C. europaea exhibited equal effectiveness against both types. Ayurvedic medicine extracts were less effective compared to plant extracts. Conclusion: This in vitro study showed the plants can dissolve GS effectively. However, the effectiveness of the plant to dissolve GS depends on the type of the stone. The findings from this study serve as a basis for further in vivo research

Distinct lipid profile in haemolytic anaemia-related gallstones compared with the general gallstone

Background Pigment gallstones are not uncommon among patients with chronic haemolytic anaemia. But their clinical characteristics have not been described in detail and not been directly compared with the general gallstone population. Methods Patients at Peking Union Medical College Hospital with haemolytic anaemia and subsequent gallstones from January 2012 to December 2022 were included. Cases were matched (1:2) based on age, sex and location of stones to randomly select non-anaemia patients with gallstones (controls). Results Screening 899 cases of gallstones, we finally included 76 cases and 152 controls. Total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) for cases were 3.02 ± 0.98 mmol/L, 0.89 ± 0.30 mmol/L and 1.58 ± 0.70 mmol/L, respectively, significantly lower than those in the control group (all p < 0.001). TC and HDL were both lower than the normal range, but triglyceride and LDL were within the normal range. Multiple stones were significantly more common for cases (n = 59, 78%) than for controls (n = 44, 29%, p < 0.001). The mean diameter of the maximal gallstone was 1.2 ± 0.6 cm and 1.5 ± 1.0 cm for cases and controls (p = 0.120), respectively. Stones in the elderly (p = 0.002 for univariate analysis, and 0.001 for multivariate analysis) and stones in the bile duct (p = 0.005 for univariate analysis, and 0.009 for multivariate analysis) were found to occur in a shorter period after anaemia. Conclusion The lipid profile of haemolytic anaemia with gallstones was distinct, low TC, low HDL, and increased-to-normal LDL, compared with the general gallstone population. Patients with haemolytic anaemia were recommended an abdominal ultrasound if aged older than 50 years, with more frequent follow-up visits. KEY MESSAGES Clinical characteristics of gallstones following chronic haemolytic anaemia were described and compared with the general gallstone population. The lipid profiles were distinctly different between the patients with gallstones following chronic haemolytic anaemia and the general gallstone population. Elder patients were complicated with gallstones in a shorter period after anaemia and thus were recommended an abdominal ultrasound if aged older than 50 years, with more frequent follow-up visits.

Chemical Analysis of Gallstones of Nepali Patients

Background: The bile concretions formed inside the gallbladder are called gallstones. Gallstone disease is one of the major causes of morbidity, mortality, and economic burden throughout the world. Approximately 10% to 20% of the world population and 4.87% in Nepal are suffering from a gallstone. Objective: The aim is to classify the gallstone samples based on morphological and cross-sectional evidences, and a comparative study of their chemical composition to understand the mechanism of formation. Method: Two types of gallstones were studied; combined cholesterol gallstone and black pigment gallstone. SEM, UV-Vis, and EDS analyzed the gallstones for morphological and elemental study. Results: The UV-Vis spectrum showed characteristic peaks for cholesterol, calcium bilirubinate, and copper bilirubinate. SEM image of combined cholesterol gallstone reveals that cholesterol is the major phase in the shell, whereas bilirubin is the major phase in the core. EDS detection of C and O as the major elements confirmed cholesterol, whereas the detection of C, O, N, and Ca as the major elements confirmed bilirubin. In the shell of the black pigment gallstone, cholesterol, calcium carbonate, calcium phosphate, and bilirubinate were detected, whereas, in the core, bilirubinate of calcium and copper, cholesterol, protein, and calcium carbonate were detected. Conclusion: Cholesterol and bilirubin are the major components of the gallstones. Metals like Al, Ca and Cu play a crucial role in the initial formation of the gallstones. The combined cholesterol gallstone has a yellow pigment center composed mainly of unconjugated bilirubin and an outer shell primarily composed of cholesterol and calcium carbonate. Precipitation of bilirubinate of calcium and copper is important during the formation of black PGS.

The potential role of vitamin E in patients with glucose-6-phosphate dehydrogenase deficiency: A systematic review and meta-analysis.

As an antioxidant, vitamin E (VitE) may benefit the erythrocytes by protecting glutathione from oxidation by free radicals and peroxide-generating processes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines when reporting this systematic review. We searched 6 electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) until May 8, 2022. We included all relevant studies. According to the study design, the Cochrane assessment tool (Risk of Bias 2), Risk Of Bias In Non-randomized Studies - of Interventions checklists, and National Institutes of Health tools were used to assess the risk of bias.Continuous data were pooled as a mean difference (MD) with a relative 95% confidence interval. The protocol was registered on PROSPERO (CRD42022333848). Six studies were included in the meta-analysis with a total of 181 patients. Compared with the control group, VitE significantly improved the hemoglobin level for chronic hemolysis (MD = 2.72 g/dL, P < .0001) and for acute hemolysis (MD = 1.18 g/dL, P < .0001). It also decreased the reticulocyte level for chronic hemolysis (MD = -1.39 P < .0001) and for acute hemolysis (MD = -1.42%, P < .0001). For before and after studies, the use of VitE significantly improved the level of packed cell volume (MD = 0.56%, P < .00001), red blood cell half-life (MD = 2.19 days, P < .0001), and decreased the reticulocytes level (MD = -1.41%, P < .00001). Among patients with glucose-6-phosphate dehydrogenase deficiency, VitE might provide benefits such as increasing the hemoglobin, packed cell volume levels, red blood cell half-life, and decreasing the reticulocyte level, so reducing hemolysis. Further high-quality, well-designed randomized controlled trials are recommended.

Effect of defatted walnut powder extract on pigment gallstones and its metabolism in vitro

Gallstones disease is classified as cholesterol, pigment and mixed gallstones. Pigment gallstones is a common disease, and some patients experienced complications such as biliary pain and cholecystitis. Defatted walnut powder extract (DWPE) is extracted from the main by-product after oil extraction of the functional food walnut and can treat cholesterol gallstones. However, the effect of DWPE on pigment gallstones has not been reported. Thus, this paper aimed at exploring the potential mechanism of alleviating pigment gallstones and the metabolism of DWPE in vitro by UPLC-Q-Exactive Orbitrap MS to elucidate potential pharmacodynamic substances. It was found that DWPE significantly reduced the incidence of gallstones, the contents of unconjugated bilirubin and calcium, the inflammation of gallbladder tissue, the edema and congestion of gallbladder tissue, and the infiltration of inflammatory cells. In metabolism, a total of 35 metabolites of DWPE, including its main compounds ellagic acid and glansreginin A, were characterized in the intestine with various metabolic reactions. Presumably, the small molecular compounds generated after the metabolism by intestinal bacteria may be the pharmacodynamic substances of DWPE on pigment gallstones. This study revealed the effect of DWPE in treating pigment gallstones and their metabolism in vitro.

Clinics in diagnostic imaging (216).

Clinics in diagnostic imaging (216).

Microstructural and heavy metal analysis of gallstones prevalent in Jharkhand and its implications in the treatment

ABSTRACT Objectives In the present study the structural and compositional analysis of gallstones was carried out by various characterization techniques. Also, the utility of the study was evaluated on how the findings can enhance the treatment and dissolution therapies of gallstones? Methods Gallstones from the Jharkhand region were analyzed both structurally as well as chemically using Field emission scanning electron microscope (FESEM) and Energy-dispersive X-ray spectroscopy, inductively coupled optical emission spectrometry (ICP-OES), Carbon hydrogen and nitrogen analyzer (CHNS), Nuclear magnetic resonance (NMR), Thermal gravimetric analysis (TGA) and Differential Thermal Analysis (DTA) and other instruments. The content of heavy metal was represented statistically as a mean with standard deviation. Results FESEM analysis unveiled the crystal and globular structure of cholesterol and pigment gallstones respectively. Through ICP-OES analysis metals such as Fe, Mn, Cu, Pb, Cr, Zn etc. were detected in gallstones. FTIR and XRD analysis confirmed the presence of cholesterol and calcium carbonate and other compounds in mixed stones and calcium bilirubinate and bilirubin in pigment gallstones. NMR analysis revealed the presence of monohydrate cholesterol (Crystalline) in Cholesterol and mixed gallstones. Mixed gallstones were found to be predominant in this region in contrast to pigmented stones that were prevalent earlier. Conclusion The present study uncovered the current composition and content of different heavy metals in gallstones of Jharkhand region which can be instrumental in enhancing the dissolution therapies for gallstone treatment. This can serve as a major tool for practitioners for gallstone treatment and change the way they are looked at.

Laparoscopic Cholecystectomy Operative Time and Hospital Stay Differences Between Sicklers and Non-sicklers: A Five-Year Comparative Cross-Sectional Study at King Abdulaziz Medical City, Jeddah.

Background Sickle cell disease (SCD) is one of the most important hemoglobinopathies that result in the formation of pigment gallstones. Laparoscopic cholecystectomy (LC) is a safe surgical procedure for gallstones in SCD. Currently, there is no standard or guidelines for the preoperative preparation of these patients. This study aims to estimate the difference in pre-operative length of stay, operative time, postoperative length of stay, and total hospitalization length of stay among patients with and without SCD in a tertiary hospital in Jeddah, Saudi Arabia. Such knowledge would aid in establishing a standard for the preoperative preparation of SCD patients for LC. Methods Data from all patients undergoing laparoscopic cholecystectomy between January 2013 and December 2018 were collected retrospectively with a comparative cross-sectional study design. Data included age, sex, BMI, clinical presentation, mode of admission (elective or emergency), preoperative length of stay, operative time, postoperative length of stay, total hospitalization length of stay, and type of surgery (day or inpatient). JMP 15.2.1 was used for statistical analysis. Results From 2013 to 2018, 793 patients underwent LC, and of those, 16 (2.018%) were SCD patients. The results showed significant differences in preoperative (p<0.001), postoperative (p<0.001), and total hospitalization stay time (p<0.001) between the SCD patients and non-SCD patients. However, the data show no significant difference in the operative time of LC between the two studied groups. Conclusion SCD is the most common hemoglobinopathy-causing gallstone. Challenges in these patients are mainly in peri-operative management. Further prospective cohort studies are needed to create a standardized approach for peri-operative management of SCD patients to facilitate delivery of the same level of care and shorten total hospitalization time.

S1759 Management of Bouveret Syndrome: A Case Report

Introduction: Bouveret syndrome is an unusual complication of gallstone disease, causing less than 0.2% of small bowel obstructions. It often requires multidisciplinary approaches for treatment. We present here a unique case report of Bouveret syndrome, managed successfully using Holmium LASER alone. Case Description/Methods: A 74-year-old man presented to our hospital with vomiting, decreased appetite, periumbilical pain and nausea. He denied heartburn, fever, chills or jaundice. His past medical history was significant for cardiomyopathy (EF 35%), atrial fibrillation and ventricular tachycardia with AICD placement. He had been admitted 3 months prior with acute cholecystitis and elevated liver function tests. Due to cardiac comorbidities, he was treated with IV Zosyn, cholecystostomy tube and ERCP with sphincterotomy with improvement and he was discharged. 6 weeks later, a tube check confirmed correct placement of the tube and decompression of the gall bladder. This time, his pain differed from the right upper abdominal pain of prior admission. His tube drainage had reduced considerably in the previous day. Physical examination revealed epigastric and supraumbilical tenderness with no guarding or rebound. The cholecystostomy bag had purulent drainage. WBC count was 11.95 x 10,000/cu.mm; liver enzymes and S. Lipase were normal. CT scan showed a change in the position of a previously seen large gallstone, measuring 3.7 cm in diameter. During the previous admission, it was in the gall bladder neck. At this time, it was occupying the duodenal bulb lumen, indicating development of a cholecystoduodenal fistula, and causing complete obstruction. The surgical team recommended endoscopic treatment due to anticipated friability of the tissue (Figure). Endoscopic evaluation showed complete obstruction of the duodenal bulb by a large smooth stone, not allowing passage of even a guidewire beyond the stone. Lithotripsy was chosen to help relieve the obstruction. 410 micron and 990 micron Holmium LASER probes were used with assistance from Urology, via an antegrade approach from the pylorus through a gastroscope. After 2 sessions of lithotripsy 4 days apart, each breaking through pigmented and calcified stone, the stone passed through the small bowel, relieving the obstruction. Discussion: The patient did not require surgical intervention and has recovered well. This case illustrates the feasibility of Holmium LASER to treat heavily calcified and pigmented gallstones. Holmium LASER should be developed for use in GI Endoscopy.Figure 1.: Gallstone obstructing duodenal bulb; LASER lithotripsy of calcified and pigmented stone; residual ulcer in duodenal bulb after stone passed.

Features of gallstones in adult sickle cell patients

Morpho-constitutional analysis of gallstones revealed significant differences between sickle cell patients and other gallbladder stone formers. As expected, pigment stones, mainly composed of calcium bilirubinates, were the most common type of stones in the former (74.7 versus 22.5%, p<10 -6 ), which could be explained by haemolysis. However, if we consider that only 25% of sickle cell patients form stones in the bile ducts, this suggests that other factors could be involved such as mutations in the UGT1A1 gene. While calcium phosphates were found with the same frequency as the main component of gallstones in both groups, a high proportion of gallstones that had nucleated from carbapatite were observed in sickle cell patients in comparison to patients without sickle cell disease (23.5% versus 5.5%, p<0.0001). In addition, among sickle cell patients, those who were homozygous were more prone than heterozygous subjects to form pigment gallstones from calcium phosphate (31.4 versus 5.9%, p<0.01).

Clinical progress note: Noncardiac complications in adults with congenital heart disease.

Clinical progress note: Noncardiac complications in adults with congenital heart disease.

Complications lithiasiques chez les patients drépanocytaires

Chronic haemolysis exposes patients with sickle cell disease (SCD) to the development of black pigment gallstones, which can trigger biliary complications. In order to avoid these complications, elective cholecystectomy is recommended in France for all SCD patients with detected gallstones. However, all surgeries, and especially abdominal surgeries, entail an increased risk of vaso-occlusive complications in the peri- and post-operative periods, the most dreadful one being the acute chest syndrome. Preoperative transfusion has been shown in several studies to reduce acute postoperative complications, but exposes the patient to definitive alloimmunization, or even delayed post- transfusion haemolysis, justifying a recent trend towards transfusion sparing. The conditions for avoiding transfusion for a simple and frequent surgery such as cholecystectomy are based on a benefit- risk balance, and must be discussed on a case-by-case basis by the SCD specialist. In particular, it seems fully justified to perform prophylactic preoperative transfusion in patients with a history of recent vaso-occlusive crisis or acute chest syndrome (within 6 months preoperatively), and those operated on in an emergency setting, who are particularly at risk of postoperative events.

Gallstone Disease and Bacterial Metabolic Performance of Gut Microbiota in Middle-Aged and Older Patients.

BackgroundGallstone disease (GSD) is more commonly presented in aged people.PurposeThe purpose of the study was to explore the insights of metabolic performance of bacterial species from gut microbiota as well as the clinical background in middle-aged and elderly patients with GSD.Patients and MethodsThis is an observational study concerning 120 research participants. Of those, 90 patients with symptomatic GSD addressed for cholecystectomy, average age 59.83 ± 15.32 years: 45 with cholesterol rich gallstones (CGSs), 45 with pigment gallstones (PGSs) and 30 healthy controls joined this observational study. Clinical examination, lab work-ups, upper and lower digestive video-endoscopies, abdominal ultrasound/CT and gallbladder motility assessment by Dodd’s method were performed. Overall stool dysbiosis (DB) was assessed as 1 = minor, 2 = mild, 3 = severe, species being identified by matrix-assisted laser desorption ionization method. Stool samples from dysbiotic patients were analyzed by a next generation sequencing method with operational taxonomic unit identification.ResultsPatients with GSD presented with a significant high range of overall gut DB (p < 0.0001) when compared with controls. Those with CGSs compared with those having PGSs displayed significant clinical differences related to elderly age, lifestyle and diet particularities, obesity, dyslipidemia, nonalcoholic fatty liver disease, hypertension, type 2 diabetes mellitus or impaired glucose tolerance, as well as motility disturbances of gallbladder with a decrease of the ejection fraction. Significant increase of overall DB range and alterations of several functional bacterial species with a decrease of butyrate, lactate, acetate/propionate and methane producers, mucin degrading bacteria, biodiversity index of microbiota, as well as an increase of lipopolysaccharide positive bacteria were significantly present in patients with CGSs.ConclusionMiddle-aged and elderly patients with GSD and a clinical background characterized by particular lifestyle, metabolic and gallbladder motility issues displayed significant modifications of biodiversity, overall gut DB and alterations of several functional bacterial species, with a decrease of their metabolic performance.