Common bile duct stones are mainly brown and associated with duodenal diverticula.

Sandstad, Olav; Osnes, Terje; Skar, Viggo; Urdal, Petter; Osnes, M

doi:10.1136/gut.35.10.1464

Cited by 39 publications

(24 citation statements)

References 27 publications

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“…Due to the difficulty of obtaining both bile and stones at the same time at ERC, the composition of stones was not investigated in this study, but we have previously found that about 70% of common bile duct stones in our Scandinavian patient population are brown, even with coexisting cholecystolithiasis [8], Our patient population differs considerably from series obtained at cholecystecto my or even laparoscopic surgery, and may not be directly comparable with such series. Our patients are those referred for ERC in a tertiary care endoscopy unit where the mean age of the general patients population is 75 years, 56% arc women, and the primary problem is more frequently those of common duct stones rather than gall bladder stones.…”

Section: Lps |)-Glucuronidase and Choledocholithiasismentioning

confidence: 58%

“…Both the old age and lack of a clear female predominance makes it likely that most stones are brown pigment stones also in this material. Black stones were rare [8], similar to what is found in Americans of Scandinavian descent [3]. Even migrating stones from the gallbladder, once entering the common bile duct, will be exposed to the lithogenicity of common duct bile which usually favors pigmentary salt deposition [27], Migrating stones may thus serve as foreign material in the common duct.…”

Section: Lps |)-Glucuronidase and Choledocholithiasismentioning

confidence: 79%

“…Common duct gallstones, in particular brown pigment stones, are associated with bacteria in the bile [1][2][3][4], The debate as to the role that bacteria play in gallstone patho genesis, continues [5] and has recently been revived [6,7], We have recently shown that common duct stones col lected at endoscopic retrograde cholangiography (ERC) in a Scandinavian population, are mainly of the brown pig ment type [8], Bacteria producing P-glucuronidase [9] have been identified in about 70% of bile samples from patients with common duct stones [10]. P-Glucuronidase can hydrolyse bilirubin glucuronides in the bile, liberating unconjugated bilirubin.…”

Section: Introductionmentioning

confidence: 99%

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Lipopolysaccharides and Beta-Glucuronidase Activity in Choledochal Bile in Relation to Choledocholithiasis

Osnes¹,

Sandstad²,

Skar³

et al. 1997

Digestion

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Common duct gallstones are mainly of the brown pigment type, which are usually attributed to bacterial factors. Bacterial β-glucuronidase most probably plays a role in the pathogenesis in many but not all patients. The role of other bacterial factors is more undecided. The aims of this study were to investigate a possible association between lipopolysaccharides (LPS) and choledocholithiasis, and to examine the interrelationship to β-glucuronidase. Common duct bile obtained at endoscopic retrograde cholangiography in 86 patients was assayed for LPS by a limulus amebocyte lysate test, and β-glucuronidase activity at pH 7.0 was measured. We found that both elevated concentration of LPS and the presence of juxtapapillary duodenal diverticula were associated with common duct stones (p < 0.01, both). Patients who had their common duct stones removed recently had a lower LPS concentration and a lower activity of β-glucuronidase than those who had a stone in situ (p < 0.01 both), but still higher LPS concentration than those without choledocholithiasis at all (p < 0.01). In multiple logistic regression analysis, elevated LPS was the significant predictor of common duct stones (p < 0.01), and not confounding with neither β-glucuronidase nor juxtapapillary diverticula. We conclude that gram-negative bacteria convey bacterial factors associated with choledocholithiasis, by mechanisms independent of, and additional to β-glucuronidase.

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Section: Lps |)-Glucuronidase and Choledocholithiasismentioning

confidence: 58%

Section: Lps |)-Glucuronidase and Choledocholithiasismentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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Lipopolysaccharides and Beta-Glucuronidase Activity in Choledochal Bile in Relation to Choledocholithiasis

Osnes¹,

Sandstad²,

Skar³

et al. 1997

Digestion

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“…), of the stones were compared with those of 1 mg pure cholesterol (Sigma, St. Louis, Mo., USA) or bilirubinate [5]. For analysis of cholesterol content a wavelength of 1,055 cm –1 and for bilirubinate wavelengths of 1,662 and 1,622 cm –1 were chosen for quantitation [4, 6]as previously reported [1]. …”

Section: Methodsmentioning

confidence: 99%

“…Common bile duct stones are mainly brown pigment stones, containing only small amounts of cholesterol [1]. Factors leading to precipitation and aggregation of calcium bilirubinate, proteins and fatty acids that make up the main components of brown stones are uncertain.…”

Section: Introductionmentioning

confidence: 99%

Structure and Composition of Common Bile Duct Stones in Relation to Duodenal Diverticula, Gastric Resection, Cholecystectomy and Infection

Sandstad¹,

Osnes²,

Skar³

et al. 2000

Digestion

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Background: Common bile duct stones represent a clinical problem often involving severe infection, cholangitis and cholestasis. Stasis and infection are thought to play a part in the pathogenesis of choledocholithiasis. Investigations on the etiology of common bile duct stones are, however, scarce because of the difficult access to common bile duct stones and bile. In a clinical series of common bile duct stones, we studied the gross appearance of stones extracted endoscopically from the common bile duct and measured the cholesterol and bilirubinate content in order to elucidate factors of importance to etiology. Methods: In 135 patients treated endoscopically for bile duct stones, the stones or parts of the stones were collected. Appearances of the cut surface of the stones were studied and described. Cholesterol and bilirubinate content were analyzed enzymatically and with infrared spectroscopy. The growth in bile of gas-producing bacteria previously shown to be correlated with enterobacteriacea was investigated. Results: Seventy-five percent of the stones were pigment stones, the majority with concentric pigmented layering. There was good agreement between cholesterol measurements. With a cutoff at 50% for the infrared measurements and 25% for the enzymatic assay only 3 stones were discordant between cholesterol measurements and visual inspection. Twenty-one of 23 patients with a previous Billroth-II gastric resection had pigment stones (p < 0.05). Gas-producing bacteria were significantly more prevalent in the bile from patients with layered pigment stones. Conclusion: Pigment stones with concentric layering highly suggestive of a cyclic process of crystallization were recovered from the common bile duct in 70% of the patients in our series.

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Gallstones and Inflammatory Gallbladder Diseases

Sherlock¹,

Dooley²

2001

Diseases of the Liver and Biliary System

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Common bile duct stones are mainly brown and associated with duodenal diverticula.

Abstract: This study investigated the composition of common duct gall stones from 61 patients, aged

Cited by 39 publications

References 27 publications

Lipopolysaccharides and Beta-Glucuronidase Activity in Choledochal Bile in Relation to Choledocholithiasis

Lipopolysaccharides and Beta-Glucuronidase Activity in Choledochal Bile in Relation to Choledocholithiasis

Structure and Composition of Common Bile Duct Stones in Relation to Duodenal Diverticula, Gastric Resection, Cholecystectomy and Infection

Gallstones and Inflammatory Gallbladder Diseases

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