Association between diet and gallstones of cholesterol and pigment among patients with cholecystectomy: a case-control study in Korea

BACKGROUND

The prevalence of cholesterol gallstones is high in Western populations, while pigment gallstones are common in Asian populations. Dietary factors are suggested to be associated with gallstone risk, but their relationship with gallstone type has not been evaluated. This study investigated the association between diet and risk of cholesterol gallstone or pigment gallstone in a Korean population whose dietary pattern and type of gallstone were changed during the last 30 years.

METHODS

Patients with cholesterol (n = 40) and pigment (n = 59) gallstones were recruited after laparoscopic cholecystectomy and were compared with those of age- and sex-matched controls without gallstones (n = 99). Dietary intakes were assessed by trained dietitians using a semi-quantitative food frequency questionnaire. Multinomial logistic regression analysis was performed to calculate odds ratios and 95% confidence intervals to examine the associations between diet and risk for type of gallstones adjusted by potential confounders.

RESULTS

Patients with cholesterol gallstone consumed more lipid, animal lipid, beef, pork, and fried food than those with pigment gallstones and control, while patients with pigment gallstone consumed more carbohydrate and noodles than patients with cholesterol gallstone and control. In multinomial logistic regression analysis using control as reference group, dietary pattern with high consumption of beef, pork, and fried food was associated with risk of cholesterol gallstones, while there was no association between the risk of pigment gallstone and dietary pattern. In addition, control consumed more alcohol than patients with cholesterol and pigment gallstones.

CONCLUSIONS

The present study suggested consumption of fat from meat and fried foods increased the risk of cholesterol gallstone, and intake of carbohydrate from noodles increased the risk of pigment gallstone.

Roles of sphincter of Oddi motility and serum vasoactive intestinal peptide, gastrin and cholecystokinin octapeptide

AIM: To investigate roles of sphincter of Oddi (SO) motility played in pigment gallbladder stone formation in model of guinea pigs.

METHODS: Thirty-four adult male Hartley guinea pigs were divided randomly into two groups: the control group and pigment stone group. The pigment stone group was divided into 4 subgroups with 6 guinea pigs each according to time of sacrifice, and were fed a pigment lithogenic diet and sacrificed after 3, 6, 9 and 12 wk. SO manometry and recording of myoelectric activity of the guinea pigs were obtained by multifunctional physiograph at each stage. Serum vasoactive intestinal peptide (VIP), gastrin and cholecystokinin octapeptide (CCK-8) were detected at each stage in the process of pigment gallbladder stone formation by enzyme-linked immunosorbent assay.

RESULTS: The incidence of pigment gallstone formation was 0%, 0%, 16.7% and 66.7% in the 3-, 6-, 9- and 12-wk group, respectively. The frequency of myoelectric activity decreased in the 3-wk group. The amplitude of myoelectric activity had a tendency to decrease but not significantly. The frequency of the SO decreased significantly in the 9-wk group. The SO basal pressure and common bile duct pressure increased in the 12-wk group (25.19 ± 7.77 mmHg vs 40.56 ± 11.81 mmHg, 22.35 ± 7.60 mmHg vs 38.51 ± 11.57 mmHg, P < 0.05). Serum VIP was significantly elevated in the 6- and 12-wk groups and serum CCK-8 was decreased significantly in the 12-wk group.

CONCLUSION: Pigment gallstone-causing diet may induce SO dysfunction. The tension of the SO increased. The disturbance in SO motility may play a role in pigment gallstone formation, and changes in serum VIP and CCK-8 may be important causes of SO dysfunction.

Influence of duodenal-biliary reflux on formation of bile duct pigment gallstone

AIM: To investigate the possible action and mechanism of duodenal-biliary reflux in the pathogenesis of bile duct pigment gallstone.

METHODS: Forty-eight patients were divided into three groups: polyp of gallbladder (PG, n = 10), cholecystolithiasis (CH, n = 27) and calculus of bile duct (CBD, n = 11). Bile samples were collected during operation for bacterial culture and endotoxin examination. Forty-one patients received T tube drainage after cholecystectomy and choledochotomy were divided into reflux (n = 16) and non-reflux group (n = 25) according to radionuclide examination. The activity of biliary amylase, lipase and β-glucuronidase were detected in 26 of the 41 patients.

RESULTS: The positive rate of bacterial culture was 0% in PG group, 0% in CH group and 81.8% in CBD group, and the level of endotoxin in bile was (0.003 ± 0.004) × 10^-6, (0.01 ± 0.02) × 10^-6, and (10.12 ± 4.49) × 10^-6 EU/L the above corresponding group, respectively. Compared with those in the former two groups, the positive rate and endotoxin level were higher in the latter CBD group (P < 0.01). Sixteen patients showed duodenal-biliary reflux (39.02%) among 41 patients. The activities of biliary amylase, lipase and exogenous β-glucuronidase in reflux group was significantly higher than those in non-reflux group (amylase: 79 891 ± 91 152 nkat/L vs 582 ± 928 nkat/L, P < 0.01; lipase: 86 110 ± 58 255 nkat/L vs 6 124 ± 7 500 nkat/L, P < 0.01; β-glucuronidase: 27 789 ± 13 849 nkat/L vs 15 369 ± 7 533 nkat/L, P < 0.01).

CONCLUSION: Duodenal-biliary reflux can promote the formation of pigment gallstone through bacteria, endotoxin, amylase, lipase and exogenous β-glucuronidase.

Influence of intestinal barrier function on pigment gallstone formation in guinea pig model

AIM: To investigate the possible action and mechanism of the intestinal barrier function in the pathogenesis of pigment gallstone.

METHODS: Eighty guinea pigs were randomly divided into three groups: normal group (CON), pigment gallstone group (PS) and intestinal mucosa protection group (GLN). Normal forage, pigment gallstone-forming forage and pigment gallstone-forming forage with supplemental intestinal mucosa protector (glutamine) were given to the animals of corresponding groups, respectively. The gallstone-forming rate, morphological changes of intestinal mucosa, intestinal permeability, serum endotoxin and biliary β-glucuronidase were detected after 8 wk.

RESULTS: The gallstone-forming rate was 73.9% in PS. In comparison with those in CON, the intestinal mucosa damage, serum endotoxin level [(1367±525)×10^-6 EU/L vs (77±43) ×10^-6 EU/L, P < 0.01] and activity of biliary β-glucuronidase (endogenous: from 209.8±47.5 vs 122.1±39.5 Fishman Unit, P < 0.01; exogenous: from 2206.6±983.9 vs 573.5±476.9 Fishman Unit, P < 0.01) were significantly increased in PS. In GLN, the gallstone-forming rate was decreased to 44.4%, which was markedly higher than that in PS (P < 0.05). The morphological changes of intestinal mucosa, intestinal permeability and serum endotoxin [(156±97)×10^-6 EU/L vs (1367±525)×10^-6 EU/L, P < 0.05] were notably decreased in GLN as compared with those in PS, and there was no significant difference in β-glucuronidase activity.

CONCLUSION: Intestinal barrier function is correlated with pigment gallstone formation. Intestinal barrier function disorder may promote pigment gallstone formation through bacteria translocation, endotoxemia and change of biliary β-glucuronidase activity.