Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment

Bari, Ornella de; Wang, Tony Y.; Liu, Min; Paik, Chang Nyol; Portincasa, Piero; Wang, David Q.–H.

doi:10.1016/s1665-2681(19)30975-5

Cited by 68 publications

(51 citation statements)

References 154 publications

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“…However, the mechanisms underlying the lithogenic effect of E 2 on impairing gallbladder motility function are not fully understood. Clinically, real-time ultrasonography has found that fasting gallbladder volumes and postprandial residual volumes are increased by two-fold in women after the first trimester of pregnancy compared to control healthy subjects, a condition pointing to gallbladder stasis [50]. In early pregnancy, there is a 30% decrease in gallbladder emptying rate, and in late pregnancy, incomplete gallbladder emptying leads to a large residual volume that causes biliary sludge and the retention of solid cholesterol crystals [25].…”

Section: Discussionmentioning

confidence: 99%

The deletion of the estrogen receptor α gene reduces susceptibility to estrogen-induced cholesterol cholelithiasis in female mice

Bari

Wang

Portincasa

et al. 2015

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Diseas

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Compelling evidence has demonstrated that estrogen is a critical risk factor for gallstone formation and enhances cholesterol cholelithogenesis through the hepatic estrogen receptor α (ERα), but not ERβ. To study the lithogenic mechanisms of estrogen through ERα, we investigated whether the deletion of Erα protects against gallstone formation in ovariectomized (OVX) female mice fed a lithogenic diet and treated with 17β-estradiol (E2) at 0 or 6 μg/day for 56 days. Our results showed that the prevalence of gallstones was reduced from 100% in OVX ERα (+/+) mice to 30% in OVX ERα (−/−) mice in response to high doses of E2 and the lithogenic diet for 56 days. Hepatic cholesterol secretion was significantly diminished in OVX ERα (−/−) mice compared to OVX ERα (+/+) mice even fed the lithogenic diet and treated with E2 for 56 days. These alterations decreased bile lithogenicity by reducing cholesterol saturation index of gallbladder bile. Immunohistochemical studies revealed that ERα was expressed mainly in the gallbladder smooth muscle cells. High levels of E2 impaired gallbladder emptying function mostly through the ERα and cholecystokinin-1 receptor pathway, leading to gallbladder stasis in OVX ERα (+/+) mice. By contrast, gallbladder emptying function was greatly improved in OVX ERα (−/−) mice. This markedly retarded cholesterol crystallization and the growth and agglomeration of solid cholesterol crystals into microlithiasis and stones. In conclusion, the deletion of Erα reduces susceptibility to the formation of E2-induced gallstones by diminishing hepatic cholesterol secretion, desaturating gallbladder bile, and improving gallbladder contraction function in female mice.

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Section: Discussionmentioning

confidence: 99%

The deletion of the estrogen receptor α gene reduces susceptibility to estrogen-induced cholesterol cholelithiasis in female mice

Bari

Wang

Portincasa

et al. 2015

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Diseas

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“…Symptoms and complications increase in frequency when gallstones are present > 5 years, and when they are > 10 mm in diameter[ 3 ]. The pathophysiology of pregnancy-related lithogenicity includes bile supersaturated with cholesterol, increased gallbladder volume, diminished gallbladder motility, and changes in the bile salt pool[ 4 - 7 ]. These gestational changes are largely mediated by increased levels of the gestational hormones of estrogen and progesterone[ 4 ].…”

Section: Resultsmentioning

confidence: 99%

Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography

Cappell

Stavropoulos

Friedel

2018

WJGE

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AIMTo systematically review safety/efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography (ERCP) performed during pregnancy, considering fetal viability, fetal teratogenicity, premature delivery, and future postpartum development of the infant.METHODSSystematic computerized literature search performed using PubMed with the key words “ERCP” and “pregnancy”. Two clinicians independently reviewed the literature, and decided on which articles to incorporate in this review based on consensus and preassigned priorities. Large clinical trials, meta-analyses, systematic reviews, and controlled trials were assigned higher priority than review articles or small clinical series, and individual case reports were assigned lowest priority. Dr. Cappell has formal training and considerable experience in conducting systematic reviews, with 4 published systematic reviews in peer-reviewed journals indexed in PubMed during the last 2 years, and with a PhD in neurophysiology that involved 5 years of training and research in biomedical statistics.RESULTSAdvances in imaging modalities, including abdominal ultrasound, MRCP, and endoscopic ultrasound, have generally obviated the need for diagnostic ERCP in non-pregnant and pregnant patients. Clinical experience with performing ERCP during pregnancy is burgeoning, with > 500 cases of therapeutic ERCP reported in the literature, aside from a national registry study of 58 patients. These studies show that therapeutic ERCP has a very high rate of technical success in clearing the bile duct of gallstones, and has a relatively low and acceptable rate of maternal and fetal complications. The great majority of births after therapeutic ERCP are full-term, have normal birth weights, and are healthy. A recent trend is performing ERCP without radiation to eliminate radiation teratogenicity. Systematic literature review reveals 147 cases of ERCP without fluoroscopy in 8 clinical series. These studies demonstrate extremely high technical success in endoscopically removing choledocholithiasis, favorable maternal outcomes with rare maternal ERCP complications, and excellent fetal outcomes. ERCP without fluoroscopy generally confirms proper biliary cannulation by aspiration of yellow bile per sphincterotome or leakage of yellow bile around an inserted guide-wire.CONCLUSIONThis systematic literature review reveals ERCP is relatively safe and efficacious during pregnancy, with relatively favorable maternal and fetal outcomes after ERCP. Recommendations are provided about ERCP indications, special ERCP techniques during pregnancy, and prospects for future research.

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“…Asymptomatic cholellthiasis was more frequent in patients of thin complexion, contrary to the theory that obesity and overweight are at major risk factors in the general population to any bile condition. However, as mentioned by the Association of obesity, pregnancy and asymptomatic disease a 49 percent [1][2][3]9,[24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic Colelithiasis in Pregnant Patients in the Primary Care Level

Ramirez¹,

G²

2016

Gynecol Obstet

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Background: Cholellthiasis is one of the registered causes within maternal deaths in an indirect way, with a reported up to 20% prevalence, it is considered within the main reasons for surgery in the postnatal period. Objective: To determine the frequency of asymptomatic cholellthiasis in pregnant successors of the Family Medicine Unit no. 53 (FMU 53). Material and methods: Observational, perspective, and descriptive study was conducted in the FMU 53 pregnant women who attended the service of ultrasound, size of sample was estimated taking 10% of anticipated ratio, significance of 95% and 3% of Alfa error corresponding to 348 patients. Excluding patients with diagnosis of biliary ducts pathology, biliary tract surgery patient carrier, and the ones who did not want to participate, ultrasound of biliary tract exploration took place; descriptive statistics was used for analysis and the results were presented in figures. Results: 348 Ultrasonographic studies were performed to pregnant patients, 16% (54) with presence of sonographic data of asymptomatic cholellthiasis, 66% (36) with age of 20 to 29 years, 26.5 as middle age, predominating the primigravid 41% (22) and the third trimester with 66% (33), in 74% multiple gallstones, polyps 7%, 39% thin complexion, 31% overweight and obesity and 33% with work activity. Conclusion: The incidence of asymptomatic Cholellthiasis in pregnant women of the FMU 53 is high, it predominates in primigravid patients of thin complexion , between 20 to 29 years of age, with multiple gallstones, size>5 mm and they are economically active women.

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Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment

Cited by 68 publications

References 154 publications

The deletion of the estrogen receptor α gene reduces susceptibility to estrogen-induced cholesterol cholelithiasis in female mice

The deletion of the estrogen receptor α gene reduces susceptibility to estrogen-induced cholesterol cholelithiasis in female mice

Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography

Asymptomatic Colelithiasis in Pregnant Patients in the Primary Care Level

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