Recent advances in understanding and managing cholesterol gallstones

Ciaula, Agostino Di; Portincasa, Piero

doi:10.12688/f1000research.15505.1

Cited by 59 publications

(76 citation statements)

References 217 publications

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“…There is currently an increasing number of studies about the role of the gut microbiome as a key link in the pathogenesis of GSD [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. The main factors contributing to the formation of gallstones are defective gallbladder motility, metabolism and secretion of cholesterol and bile acids [ 12 ]; the gut microbiota is actively involved in the regulation of bile acid metabolism, changing the size and composition of the bile acid pool [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Gallstone Disease and Microbiome

Григорьева

Romanova

2020

Microorganisms

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Gallstone disease (GSD) has, for many years, remained a high-cost, socially significant public health problem. Over the past decade, a number of studies have been carried out—both in humans and in animal models—confirming the role of the microbiota in various sections of the gastrointestinal tract as a new link in the etiopathogenesis of GSD. The microbiome of bile correlates with the bacterial composition of saliva, and the microbiome of the biliary tract has a high similarity with the microbiota of the duodenum. Pathogenic microflora of the oral cavity, through mechanisms of immunomodulation, can affect the motility of the gallbladder and the expression of mucin genes (MUC1, Muc3, MUC4), and represent one of the promoters of stone formation in the gallbladder. The presence of H. pylori infection contributes to the formation of gallstones and affects the occurrence of complications of GSD, including acute and chronic cholecystitis, cholangitis, pancreatitis. Intestinal bacteria (Clostridium, Bifidobacterium, Peptostreptococcus, Bacteroides, Eubacterium, and Escherichia coli) participating in the oxidation and epimerization of bile acids can disrupt enterohepatic circulation and lead to the formation of gallstones. At the same time, cholecystectomy due to GSD leads to the further transformation of the composition of the microbiota in various parts of the gastrointestinal tract, increasing the risk of developing stomach cancer and colorectal cancer. Further research is required to determine the possibility of using the evaluation of the composition of the microbiota of the gastrointestinal and biliary tracts as an early diagnostic marker of various gastroenterological diseases.

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Section: Introductionmentioning

confidence: 99%

Gallstone Disease and Microbiome

Григорьева

Romanova

2020

Microorganisms

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“…The presence of an altered postprandial gastric emptying occurs either with or without “in situ” gallbladder , suggesting that this defect is independent of the physical presence of gallstones, and possibly linked with mechanisms, which also influence gastrointestinal motility at different levels of the gastrointestinal tract . The extent and timing of gastric emptying worsen after gallbladder removal, pointing to the presence of altered pathways involving bile flow and/or signalling molecules.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal defects in gallstone and cholecystectomized patients

Ciaula

Molina-Molina

Bonfrate

et al. 2019

Eur J Clin Investigation

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Background and aim Several gallstone patients complain of dyspeptic symptoms, irrespective of the presence of typical colicky pain. Symptoms often persist after a cholecystectomy. Systematic studies on dyspepsia and dynamic gastrointestinal motor function are missing in gallstone patients with preserved gallbladder or after a cholecystectomy. Materials and methods Forty‐six gallstone patients (age 55 ± 2 years; 15M, 31F) and 24 cholecystectomized patients (age 57 ± 2 years; 6M, 18F) (no difference in type and volume of gallstones between the two groups) were compared against a group of 65 healthy controls (age 51 ± 2 years; 30M, 35F). Dyspepsia occurring in the prior months was assessed by a questionnaire, gastric and gallbladder emptying by functional ultrasonography and orocecal transit time by a hydrogen breath test using a lactulose‐enriched standard liquid meal. Results Gallstone patients had significantly greater dyspepsia, fasting and residual gallbladder volumes, and slower gallbladder emptying, gastric emptying and small intestinal transit time than controls. In cholecystectomized patients, gastric emptying further delayed, compared to gallstone patients and controls. Conclusion Gallstone patients with the gallbladder “in situ” or after a cholecystectomy display dyspeptic symptoms. Symptoms are associated with multiple gastrointestinal motility defects involving the gallbladder, stomach and small intestine. After cholecystectomy, gastric emptying worsens.

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“…Some studies have reported that UDCA had no effect on gallstones and some had an effect. There is no consensus on the medical or surgical treatment of pediatric gallstones (21,22). Cholecystectomy was an adopted treatment in all pediatric patients with symptomatic gallstone and gallstone complications (5,11).…”

Section: Discussionmentioning

confidence: 99%

Place of Cholecystectomy in Children with Uncomplicated Gallstones

et al. 2019

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Background: The incidence of gallstones in children has increased in recent years. Risk factors that increase the formation of bile duct stones have been described in children, and discussions are ongoing about surgical indications of uncomplicated gallstones. Objectives: This study aimed to investigate the impact of risk factors on gallstone-induced complications and identify surgical indications for uncomplicated gallstones in children. Methods: Patients who had a cholecystectomy in the pediatric surgery clinic between October 2011 and January 2018 were evaluated. Data including age and sex, body mass index (BMI), associated risk factors, gallstone-induced complications, postoperative complications, postoperative complaints, and pathological results were recorded. Results: Seventy-two patients were included in the study. The mean age was 13.2 years with a female-to-male ratio of 2.27:1. Obesity was the most common risk factor (25%). A total of 44% of the patients experienced a complication on admission. The risk factors had no effect on the development of complications. The patients underwent cholecystectomy, but some symptoms persisted in thirteen patients postoperatively (18.1%). Ten of these patients did not have any risk factors; however, chronic cholecystitis findings were not identified in six specimens of those with uncomplicated gallstones. Conclusions: The risk factors have no influence on the development of gallstone-induced complications in children. Gallstones were cured with cholecystectomy; however, some complaints persisted in risk-free and uncomplicated gallstones. We think that if there are no risk factors in patients with uncomplicated gallstones, the patients should not receive surgery but be closely monitored.

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Recent advances in understanding and managing cholesterol gallstones

Cited by 59 publications

References 217 publications

Gallstone Disease and Microbiome

Gallstone Disease and Microbiome

Gastrointestinal defects in gallstone and cholecystectomized patients

Place of Cholecystectomy in Children with Uncomplicated Gallstones

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