Sludge and stones in gallbladder after pregnancy

Maringhini, Alberto; Marcenò, M P; Lanzarone, Fabio; Caltagirone, Maria; Fusco, G; Cuonzo, G. Di; Cittadini, E; Pagliaro, Luigi

doi:10.1016/s0168-8278(87)80576-7

Cited by 80 publications

(31 citation statements)

References 25 publications

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“…Interest in the potential role of the CCK-1R in gallbladder emptying was enhanced by recognition of the important pathogenic relationship between bile stasis and cholesterol gallstone formation (8,9). Most notably, the association of impaired gallbladder emptying (10,11) with increased nucleation of cholesterol-supersaturated bile, biliary sludge, and gallstones late in pregnancy (12,13) affirms the crucial role of gallbladder stasis in the pathogenesis of cholesterol gallstones (8,9). Nonetheless, divergent studies (6,14) have suggested that two different gallstone subpopulations may exist, characterized by either defective or normal gallbladder motor function.…”

Section: Introductionmentioning

confidence: 85%

Targeted disruption of the murine cholecystokinin-1 receptor promotes intestinal cholesterol absorption and susceptibility to cholesterol cholelithiasis

Wang¹,

Schmitz²,

Kopin³

et al. 2004

J. Clin. Invest.

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Cholecystokinin (CCK) modulates contractility of the gallbladder, the sphincter of Oddi, and the stomach. These effects are mediated through activation of gastrointestinal smooth muscle as well as enteric neuron CCK-1 receptors (CCK-1Rs). To investigate the potential physiological and pathophysiological functions linked to CCK-1R-mediated signaling, we compared male WT and CCK-1R-deficient mice (129/SvEv). After 12 weeks on either a standard mouse chow or a lithogenic diet (containing 1% cholesterol, 0.5% cholic acid, and 15% dairy fat), small-intestinal transit time, intestinal cholesterol absorption, biliary cholesterol secretion, and cholesterol gallstone prevalence were compared in knockout versus WT animals. Analysis of mice on either the chow or the lithogenic diet revealed that CCK-1R -/-animals had larger gallbladder volumes (predisposing to bile stasis), significant retardation of small-intestinal transit times (resulting in increased cholesterol absorption), and increased biliary cholesterol secretion rates. The elevation in bile cholesterol, coupled with a tendency toward gallbladder stasis (due to the absence of CCK-induced contraction), facilitates nucleation, growth, and agglomeration of cholesterol monohydrate crystals; this sequence of events in turn results in a significantly higher prevalence of cholesterol gallstones in the CCK-1R-null mice.

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Section: Introductionmentioning

confidence: 85%

Targeted disruption of the murine cholecystokinin-1 receptor promotes intestinal cholesterol absorption and susceptibility to cholesterol cholelithiasis

Wang¹,

Schmitz²,

Kopin³

et al. 2004

J. Clin. Invest.

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“…[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] This inconsistency raised several questions, which are addressed in this review: 1. Were the older studies systematically biased by flaws in their design (or are the newer studies less valid)?…”

Section: Introductionmentioning

confidence: 99%

Oral contraceptives and the risk of gallbladder disease: a meta-analysis.

Thijs¹,

Knipschild²

1993

Am J Public Health

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OBJECTIVES. This study was designed to assess the risk of gallbladder disease due to oral contraceptive use by conducting a thorough literature review. METHODS. Controlled epidemiologic studies published through March 1992 were systematically searched and evaluated. Of 25 studies (27 publications), 9 could stand the test of critical appraisal with respect to validity. Restriction to these studies was judged to circumvent publication bias at the same time. RESULTS. Oral contraceptive use is associated with a slightly and transiently increased rate of gallbladder disease. The results of six selected studies in which asymptomatic women were screened for gallstones were strikingly similar. Pooling of these results yielded an odds ratio, for ever vs never oral contraceptive use, of 1.36. A dose-effect relationship was indicated, suggesting that modern low-dose oral contraceptives are safer than older formulas, but an effect cannot be excluded. CONCLUSIONS. Considering the large efforts already devoted to this exposure-disease relationship, the probably weak effect, and the rapidly changing formulas of oral contraceptives, the authors suggest that the safety of new oral contraceptives be evaluated by studying bile saturation and biliary function rather than by waiting for gallbladder disease to develop.

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“…Several studies implicate pregnancy itself as a risk factor in the development of gallstones. 6,14,15 Although controversial, 5,8,[15][16][17] it does seem plausible that the pregnancy state contributes to gallstone formation, based on the known metabolic changes associated with pregnancy, such as supersaruration of bile with cholesterol. 3,[17][18][19] Other suggested factors include estrogen-mediated decrease in the activity of the Na pump in the gallbladder mucosa; impairment of cholecystokinin-mediated smooth muscle contraction leading to decrease in the gallbladder contraction and increase in the residual volume of the gallbladder.…”

Section: Discussionmentioning

confidence: 99%

Management of Symptomatic Cholelithiasis in Pregnancy

et al. 2001

Annals of Saudi Medicine

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Background: Symptomatic cholelithiasis occurs in pregnancy in our patient population, some of whom are diabetic. But its management remains controversial. How common is the problem? Is our current policy of management appropriate for our patients? Patients and Methods: The management of 162 pregnant patients admitted over a ten-year period with symptomatic cholelithiasis was evaluated in a retrospective study. The patients were divided into two groups: Group A, 58 patients with diabetes mellitus, and Group B, 104 nondiabetic patients. Results: Symptomatic cholelithiasis occurred in only 0.3% of our pregnant patients. Of 162 patients, 148 (91.4%) had successful conservative (nonsurgical) management. There was no fetal loss, premature birth, maternal morbidity or mortality. Fourteen patients who had failure of conservative treatment had surgical management. When the postpartum cholecystectomy hospitalization days were added to the total days of admission for the nonoperative cases, there was a significant difference in the mean total number of days of hospitalizations between the surgical cases, 12.4 days, and the nonsurgical cases, 20.5 days (P<0.001), but not in the mean number of hospitalizations, 2.3 versus 3.3. Conclusion: Our current policy of conservative management seems optimal. It has, however, been achieved at the price per patient of 8 extra days of hospitalization. In keeping with recent improvements in surgery and the advent of laparoscopic surgery, a more cost-efficient approach would suggest a more aggressive policy.

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Sludge and stones in gallbladder after pregnancy

Cited by 80 publications

References 25 publications

Targeted disruption of the murine cholecystokinin-1 receptor promotes intestinal cholesterol absorption and susceptibility to cholesterol cholelithiasis

Targeted disruption of the murine cholecystokinin-1 receptor promotes intestinal cholesterol absorption and susceptibility to cholesterol cholelithiasis

Oral contraceptives and the risk of gallbladder disease: a meta-analysis.

Management of Symptomatic Cholelithiasis in Pregnancy

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