Gut microbial profile in primary biliary cholangitis: Towards bioindicators

Asymptomatic cholecystitis and its controversial issues in biliary surgery

Gallbladder stones are present in 10-20 % of the population of Western countries, and the incidence rate has almost tripled over the past 30 years. Asymptomatic cholecystitis is more common than it is mentioned in the literature. Approximately 80 % of the GI have no clinical manifestations. In most cases, the disease will remain asymptomatic throughout life. The problem of asymptomatic cholecystitis is often hushed up and ignored. Surgeons try to avoid examining this pathology. Works on asymptomatic cholecystitis are not only few, but also scattered. At the same time, there is no uniformity in the literature. Since the tactics of treating such patients still does not have an unambiguous approach. Many surgeons doubt the decision on surgical treatment, a smaller part chooses cholecystectomy at the same time, without substantiating the indications for it. That is why most cases of postcholecystectomy syndrome occur in patients operated on for asymptomatic cholecystitis. The unwillingness to discover the secret of stone formation and asymptomatic cholecystitis in humans when concretions in the gallbladder are detected without reference to surgery, to indicate the trajectory of the examination, leads to a number of tactical errors, preserving the risk of PES, and erasing practical recommendations for the management of such patients. The solution to this issue lies in a thorough study of each stage of the tactical search in patients with asymptomatic cholecystitis, which will determine a new strategy in biliary surgery.

Gut Microbial Profile in Asymptomatic Gallstones

There are few studies on the changes of gut microbiota in patients with gallstones, especially in patients with asymptomatic gallstones, and there are some deficiencies in these studies, for instance, the effects of metabolic factors on gut microbiota are not considered. Here, we selected 30 asymptomatic gallstone patients from the survey population, and 30 controls according to the age and BMI index matching principle. The 16SrDNA technology was used to detect and compare the structural differences in the gut microbiota between the two groups. Compared with healthy controls, the abundance of gut microbiota in patients with gallstones increased significantly, while the microbiota diversity decreased. At the level of phylum, both groups were dominated by Firmicutes, Bacteroides, Proteobacteria, and Actinobacteria. At the genus level, there were 15 species with significant differences in abundance between the two groups. Further subgroup analysis found that only unclassified Lactobacillales showed differences in the intestines of gallstones patients with hypertension, non-alcoholic fatty liver disease, or patients with elevated BMI (≧24). The structure of gut microbiota in patients with gallstones changed significantly, and this might be related to the occurrence of gallstones, rather than metabolic factors such as hypertension, non-alcoholic fatty liver disease, and obesity.

Primary Biliary Cholangitis and Primary Sclerosing Cholangitis: Current Knowledge of Pathogenesis and Therapeutics

Cholangiopathies encompass various biliary diseases affecting the biliary epithelium, resulting in cholestasis, inflammation, fibrosis, and ultimately liver cirrhosis. Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are the most important progressive cholangiopathies in adults. Much research has broadened the scope of disease biology to genetic risk, epigenetic changes, dysregulated mucosal immunity, altered biliary epithelial cell function, and dysbiosis, all of which interact and arise in the context of ill-defined environmental triggers. An in-depth understanding of the molecular pathogenesis of these cholestatic diseases will help clinicians better prevent and treat diseases. In this review, we focus on the main underlying mechanisms of disease initiation and progression, and novel targeted therapeutics beyond currently approved treatments.