The Role of Bacteria in Gallbladder and Common Duct Stone Formation

Kaufman, Howard S.; Magnuson, Thomas; Lillemoe, Keith D.; Frasca, Peter; Pitt, Henry A.

doi:10.1097/00000658-198905000-00011

Cited by 124 publications

(62 citation statements)

References 28 publications

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“…Pigment stones were associated with positive bacterial culture, as observed in other studies [3,10,13], Because stones from the bile duct are mainly of the pigment type, bile duct stones are also associated with positive bacterial culture. It has been reported [3,12,13] that bacterial infection and bacterial (J-glucuronidase may play a key role in the pathogenesis of pigment stones.…”

Section: Discussionsupporting

confidence: 78%

“…Positive bacterial culture, which reflects biliary bacte rial infection, is reportedly observed in 20-40% of the patients with gallstones [10,11]. However, in our study this percentage was higher (57%).…”

Section: Discussioncontrasting

confidence: 72%

“…Cholesterol stones were obtained from 54 patients, and pigment stones from 44 (table 1). In this population, bile duct and pigment stones were more frequent than in other recently reported studies [10,11].…”

Section: Bacteriologycontrasting

confidence: 54%

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Biliary Level of Amylase in Gallstone Patients Associated with Bacterial Infection

Nishida¹,

Nakashima²,

Tanaka

et al. 1992

Dig Surg

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To assess the role of pancreatic enzymes in the formation of gallstones, we examined bile and stones from 112 consecutive gallstone patients undergoing cholecystectomy and/or bile duct exploration. The bacterial culture of bile was positive in 95 and 91 % of the cases with pigment stones and bile duct stones, respectively. Amylase activity, which was correlated with lipase activity, was higher in septic than in sterile bile, and was also high in patients with pigment and bile duct stones. These results clearly imply that pigment stones are associated with both an increase in pancreatic enzymes and bacterial infection.

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Section: Discussionsupporting

confidence: 78%

Section: Discussioncontrasting

confidence: 72%

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Biliary Level of Amylase in Gallstone Patients Associated with Bacterial Infection

Nishida¹,

Nakashima²,

Tanaka

et al. 1992

Dig Surg

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“…The real incidence of primary CBD stone is controversial and varies widely from 4% to 56%, according to the different methods of identification or definition [4] [5]. Biliary infection and biliary stasis have been implicated as important factors in formation of primary duct stones [6].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Choledochoduodenostomy for Biliary Alleviation

Okamoto¹,

Maruyama²,

Takahashi³

et al. 2017

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Choledochoduodenostomy (CDD) was very useful alternatives for treatment for patients with common bile duct (CBD) stones, especially recurrent stones, giant stones with choledochal dilatation, and difficult or failed cases by endoscopic treatment. Furthermore, CDD was also applied to biliary bypass by malignant obstruction. In these days, minimal invasive laparoscopic approach is adapted in these disorders. We have conducted to perform a laparoscopic CDD for biliary alleviation for patients with endoscopic management of difficult CBD stone with choledochal dilatation. A side-to-side CDD was created intra-corporeally using water-tight running absorbable suture by handmade 4-0 monofilament with double side needles, starting from the right side of choledochus, and continued along posterior wall until the left side of the choledochus followed by anterior-wall anastomosis as the same manner. Five patients were treated successfully by this laparoscopic procedure and remained well without bile leakage and reflux cholangitis for the short-term follow-up. The median operative time and intracorporeally anastomosis time were 182 (167 -209) min and 33 (30 -38) min, respectively. Median blood loss was 32 (little-90) ml, median hospital stay was 7 (5 -14) days, and median follow-up time was 18 months. Although this series was relatively small, this laparoscopic technique is feasible and safe for biliary alleviation, especially for endoscopic management of difficult or failed CBD stones, and would also potentially adapt to biliary bypass by malignant obstruction.

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“…In a SEM (scan-ning electron microscopy) study, bacteria were observed only within the calcium bilirubinate-protein matrix of brown pigment stones (P < 0.001). In comparison to black pigment stones, brown stones were more likely to contain calcium palmitate (P < 0.005) and cholesterol (P < 0.001) (19). Bacterial properties determine the path of gallstone formation, for instance, β-glucuronidase and urease activity are involved in calcium precipitation in cholesterol and pigmented stones, respectively.…”

Section: Introductionmentioning

confidence: 99%

Urease Positive and Slime Producing Bacterial Activity: Results in Gallstone Precipitation and Solidification

Sharma

Sachan

Sharma

2013

Arch Clin Infect Dis

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Background: Bacteria are commonly isolated from gallstones. Presence of bacteria in gallstones might play a role in their formation. Objectives: We aimed to study different properties of isolates from gallstones and their relationship with the mechanism of gallstone formation. Patients and Methods:This study included 526 subjects. Gallstones and bile samples of the patients were cultured. Isolates were identified by different biochemical tests and examined for their β-glucuronidase activity, slime production and Urease activity. Biostatistical analyses were done to determine the relationship between the biliary bacterial factors and the types of gallstones. Role of Slime and urease activity in mechanism of gallstone formation were tested in vitro. Results: Overall, 94.77% of the gallstones were found to be infected, of which 85% of the cholesterol stones, 97% of pigmented stones and 100% of mixed stones showed the presence of bacterial isolates (P < 0.0001). β-glucuronidase activity was associated with isolates from pigmented or mixed stones and completely absent in cholesterol gallstones (P = 0.018). Urease activity was basically associated with cholesterol gallstones (P < 0.0001) while slime (P < 0.0001) activity was not specific for any single type of stone formation yet isolates of bile had a significant association with slime activity. In vitro analysis demonstrated that bacteria with urease activity are involved in CaCO 3 precipitation and slime-producing isolates solidify the precipitated CaCO 3 . Conclusions: β-glucuronidase activity is mainly responsible for pigmented gallstone formation. Urease activity was predicted to be involved in nucleation and slime production during solidification of gallstones, as observed during in vitro studies. Hence, presence of these bacterial factors may enhance gallstone formation.

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The Role of Bacteria in Gallbladder and Common Duct Stone Formation

Cited by 124 publications

References 28 publications

Biliary Level of Amylase in Gallstone Patients Associated with Bacterial Infection

Biliary Level of Amylase in Gallstone Patients Associated with Bacterial Infection

Laparoscopic Choledochoduodenostomy for Biliary Alleviation

Urease Positive and Slime Producing Bacterial Activity: Results in Gallstone Precipitation and Solidification

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