Sphincter of Oddi laxity alters bile duct microbiota and contributes to the recurrence of choledocholithiasis

Abstract

Background: Choledocholithiasis is closely associated with bacterial infection and inflammation in the bile duct. Our previous studies showed that sphincter of Oddi laxity (SOL) significantly altered the bile microbiota and might contribute to the recurrence of biliary stones. However, the direct association among SOL, the bile microbiota, and choledocholithiasis recurrence is unclear.Methods: We prospectively recruited 202 patients with choledocholithiasis, and obtained bile samples from the common bile duct. We performed 16S ribosomal RNA gene analysis to characterize the bile microbiota and analyzed the risk factors for choledocholithiasis.Results: Distinct bile microbial communities were identified in patients with and without SOL, with a significantly larger abundance of Rhizobiaceae in patients with SOL. Patients with SOL had a higher risk of biliary stone recurrence, with a considerably shorter recurrence time. The abundance of Clostridium was significantly higher in patients with stone recurrence. SOL [P=0.024, hazard ratio (HR) =10.800, 95% confidence interval (CI): 1.377-84.701] was an independent risk factor of choledocholithiasis recurrence.Conclusions: Choledocholithiasis patients with and without SOL demonstrated significant differences in their microbial communities. SOL is a critical risk factor for the recurrence of choledocholithiasis after surgery. The presence of Clostridium may be potentially associated with the recurrence of SOL-induced choledocholithiasis.

Causes and surgical management of choledocholithiasis after cholecystectomy

“…The second is ascending infection whereby intestinal bacteria enter the biliary tract via the duodenal papilla. Oddis sphincter dysfunction can cause the back-ow of intestinal juice with bacteria into the biliary tract [15,16,19]. Based on our experience, intraoperative exploration of the bile ducts has shown abnormal structure and dysfunction of the Oddis sphincter at the lower end of the bile duct in 60-80% of patients with primary hepatolithiasis.…”

“…This nding may be explained by the physiological functions of the gallbladder. The biliary system is comprised of complex interactions between the intrahepatic bile ducts, gallbladder, extrahepatic bile ducts, and duodenal papilla [5,19,24]. The function of the gallbladder and the duodenal papilla (Oddis sphincter) is mainly to regulate the bile excretion.…”

“…The duodenal papilla (Oddis sphincter) mainly regulates the excretion of bile, which is related to the structure and function of the Oddis sphincter [25,26]. Its functions include ensuring the one-way ow of the bile and pancreatic juice, regulation and maintenance of pressure in the biliary tract, preventing the re ux of duodenal juice, and preventing the biliary infection [19]. In the case of an Oddis sphincter with normal structure and function, if cholecystectomy is performed the biliary system will compensate through dilating the common bile duct.…”

“…If the structure and function of the Oddis sphincter become abnormal, the anti-re ux function of the Oddis sphincter is compromised, and duodenal juice with some bacteria may enter the common bile duct, resulting in a biliary infection [19]. In addition, mild dilation of the common bile duct causes cholestasis, which accelerates the formation of stones in the common bile duct.…”

Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients

“…Due to the dysfunction of the sphincter of Oddi, CBD that enters the duodenum at a right angle is more prone to intestinal fluid reflux. Because intestinal fluid contains digestive juices, food residues, and a large number of bacteria, once reflux occurs, it causes the bile duct loop change and predisposes to bile duct infection[ 19 ].…”