Relationship between intraduodenal peri-ampullary diverticulum and biliary disease in 178 patients undergoing ERCP

BACKGROUND:The presence of intraduodenal peri-ampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography(ERCP).A few papers in China and overseas reported that the diverticulum had something to do with the incidence of cholelithiasis. This study was undertaken to further test this notion and ascertain the relationship between intraduodenal peri- ampullary diverticulum and biliary disease,especially the formation of bile duct pigment stones. METHODS:A total of 178 patients who had undergone ERCP or endoscopic sphincterotomy(EST)were studied retrospectively.They were divided into 6 groups according to the category of biliary disease,and the incidence rates of intraduodenal peri-ampullary diverticulum were calculated. RESULTS:There were 44 patients with intraduodenal peri- ampullary diverticulum in 81 patients with primary bile duct pigment stones(54.32%),4 in 8 patients with bile duct stones and gallbladder stones(50%),7 in 33 patients with bile duct stones secondary to gallbladder stones(21.21%), 3 in 21 patients with inflammation and stricture of the end of the bile duct and papilla(14.29%),1 in 22 patients with carcinoma of the end of the bile duct and papilla(4.54%), and 5 in 13 patients with post-cholecystectomy syndrome or sphincter of Oddi dysfunction(38.46%). CONCLUSIONS:The incidence rate of intraduodenal peri- ampullary diverticulum in patients with primary bileduct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones,patients with inflammation and stricture of the end of the bile duct and papilla,and patients with carcinoma of the end of the bile duct and papilla.These findings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones.

Possible relationship between intestinal barrier function and formation of pigment gallstones in hamsters

BACKGROUND:The presence of bacteria in bile is an important factor in the formation of pigment gallstones The bile of healthy people is sterile and bacteria in the biliary system come from endogenous infection from the gut.Yet,the route of bacterial translocation into the bile duct is still unclear.Theoretically,two routes exist: one is through the intestinal barrier and the other is by direct reflux from the sphincter of Oddi.This study was undertaken to explore the relationship between the effectiveness of intestinal barrier and the formation of pigment gallstones in hamsters. METHODS:Thirty-two hamsters were divided into an experimental and a control group,with 16 hamsters in each group.A low protein and high cellulose diet was given for 6 weeks to induce the formation of pigment gallstones in the experimental group(PS)and a normal diet was given to the control group(CON).Morphological changes,changes in the levels of serum endotoxin and diamine oxidase,and changes in the numbers of B lymphocytes,plasma cells and secretory immunoglobin A(sIgA)in the intestinal mucosa were assessed after 6 weeks. RESULTS:Four hamsters died during lithogenesis and body weight decreased in the PS group.Pigment gallstones were found in 11 hamsters at the end of the experiment giving a lithogenesis rate of 91.67%.The serum endotoxin level before and after gallstone formation in the PS group was 0.2960±0.1734 U/ml and 8.2964±4.6268 U/ml respectively(P<0.05).The blood diamine oxidase level before and after gallstone formation in the PS group was 2.6333±0.8037 U/ml and 3.3642±0.9545 U/ml,respectively (P<0.05).The numbers of B lymphocytes,plasma cells and sIgA in the intestinal mucosa in the PS group were 71.56±2.89,68.65±2.09 and 27.56±1.07,respectively,and were significantly decreased compared with the corresponding values in the CON group(94.25±3.69,93.47±3.98 and 42.57±1.96,respectively,P<0.05). CONCLUSIONS:A low protein and high cellulose diet can markedly reduce intestinal barrier function and facilitate the formation of pigment gallstones.The decrease of intestinal barrier function may take part in the formation of pigment gallstones.

Differences and significance of motilin,vasoactive intestinal peptide and gastrin in blood and gallbladder tissues of patients with gallstones

BACKGROUND: The disorders of gallbladder motility may play an important role in the formation of gallstones. Many neural and hormonal factors and their interactions regulate gallbladder motility and bile flow into the duodenum. Further study in these factors may help to reveal the etiology of gallbladder diseases. This study was undertaken to assess the relationship of the levels of motilin, vasoactive intestinal peptide (VIP) and gastrin in blood and gallbladder tissues with the formation of cholelithiasis. METHODS: The levels of motilin, gastrin and VIP in blood and gallbladder tissues of 36 patients with gallbladder stones, 14 patients with gallbladder polyps, 10 healthy volunteers and 10 patients with common bile duct stones were measured by radioimmunoassay. RESULTS: The level of motilin in plasma and gallbladder tissues of the gallbladder stone group was higher than that of the control and gallbladder polyp groups (P<0.05). The levels of plasma VIP and serum gastrin were much higher than those of the other three groups (P<0.01). The level of VIP in gallbladder tissues was higher than that of the control and gallbladder polyp groups (P<0.01).CONCLUSIONS: The abnormal excretion of hormonal factors is closely related to gallstone formation. The high level of VIP in gallbladder tissues may be an important cause of gallbladder hypomotility. The abnormal level of serum gastrin may be related to the gastrointestinal symptoms of patients with gallstones.

Effect of intestinal transit on the formation of cholesterol gallstones in hamsters

BACKGROUND:The effect of"intestinal transit"has become a new field of interest in the study of the pathogenesis of cholesterol gallstones.This study was undertaken to further test this notion and ascertain the relationship between impaired intestinal transit function and cholesterol gallstones. METHODS:A total of 64 hamsters were divided into 2 groups,experimental and control.Each was subdivided into 4 subgroups for sacrifice at different time.A high- cholesterol diet and a standard diet were fed to each group. The geometric center,which represents the intestinal transit function was calculated. RESULTS:The growth of all hamsters was normal. Cholesterol gallstones were found in 2 hamsters at the end of the 4th week.The geometric center values for the experimental and control groups were 2.3891±0.3923 vs.2.7730±0.5283,at the end of week 3;1.8148±0.4312 vs. 3.2294±1.1613 at week 4;1.8451±0.3700 vs.2.9075±0.3756 at week 5;and 1.8025±0.3413 vs.3.0920±0.5622 at week 6. CONCLUSION:A high cholesterol diet can significantly reduce the intestinal transit function and facilitate the formation of cholesterol gallstones.