Effects of Diet on Glucaric Acid Concentration in Bile and the Formation of Calcium Bilirubinate Gallstones

Matsushiro, Takashi; Suzuki, Noriyoshi; Sato, Toshio; Maki, Tetsuo

doi:10.1016/s0016-5085(77)80145-5

Cited by 58 publications

(12 citation statements)

References 17 publications

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“…64,65 A low-protein Asian diet contributes to decreased level of glucuro-1:4-lactone in the bile that normally inhibits b-glucuronidase. 66 The role of the diet apparently accounts for the steady decline in the incidence of HL in recent years. 26,66 With the formation of biliary sludge, transient otherwise innocuous portal bacteremia is converted into pathogens in the biliary system, as a result of bile stasis, which is further enhanced by the ensuing uneven dilatation and stricture of bile ducts.…”

Section: Pathogenesismentioning

confidence: 99%

“…66 The role of the diet apparently accounts for the steady decline in the incidence of HL in recent years. 26,66 With the formation of biliary sludge, transient otherwise innocuous portal bacteremia is converted into pathogens in the biliary system, as a result of bile stasis, which is further enhanced by the ensuing uneven dilatation and stricture of bile ducts. Once infection is established in the biliary tract, the concentration of glucuronidase of bacterial origin in the bile is increased.…”

Section: Pathogenesismentioning

confidence: 99%

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Hepatolithiasis and the Syndrome of Recurrent Pyogenic Cholangitis: Clinical, Radiologic, and Pathologic Features

et al. 2011

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Primary hepatothiasis (HL) and recurrent pyogenic cholangitis (RPC) are two terms describing the different aspects of the same disease, with HL emphasizing the pathologic changes and RPC emphasizing the clinical presentation and suppurative inflammation. It is predominantly a disease of the Far East. In the 1960s, it was the third most common cause of emergency abdominal surgery at a university hospital in Hong Kong. Thereafter, its incidence has decreased considerably, possibly due to improved standards of living and Westernized diet. Clinically, patients may present acutely with recurrent bacterial cholangitis and its possible complications, such as liver abscess and septicemic shock, or with chronic complications, such as cholangiocarcinoma. Pathologically, it is characterized by pigmented calcium bilirubinate stones within dilated intrahepatic bile ducts featuring chronic inflammation, mural fibrosis, and proliferation of peribiliary glands, without extrahepatic biliary obstruction. Episodes of suppurative inflammation cumulate in sclerosing cholangitis of peripheral ducts and parenchymal fibrosis resulting from collapse and scarring. Mass-forming inflammatory pseudotumor and neoplasms like intraductal papillary neoplasms and cholangiocarcinoma are increasingly recognized complications. Modern imaging techniques allow definitive diagnosis, accurate assessment for treatment planning, and detection of complications. A multidisciplinary team approach (interventional endoscopist, interventional radiologist, hepatobiliary surgeon, and intensivists) is important for optimal patient outcome.

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Section: Pathogenesismentioning

confidence: 99%

Section: Pathogenesismentioning

confidence: 99%

Hepatolithiasis and the Syndrome of Recurrent Pyogenic Cholangitis: Clinical, Radiologic, and Pathologic Features

et al. 2011

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“…However, Japanese workers have suggested that normal bile does contain P-glucuronidase, whose activity is nullified by inhibitors, such as bile acids (63) and glucaric acid (64, 65). Changes in levels of glucaric acid are related to diet (64) in both experimental animals and in man, suggesting a mechanism whereby dietary manipulations can engender pigment stone formation. The activity of p-glucuronidase could also be enhanced by acidification of the bile (e.g., in infected bile), shifting the ambient pH values closer to the optimum for the enzyme; it is unclear if this is an important factor in natural pigment stone disease in man.…”

Section: Factors Leading To Supersaturation Of Bile With Calcium Bilimentioning

confidence: 99%

The Etiology of Pigment Gallstones

Ostrow

1984

Hepatology

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Pigment gallstones are of two major types, black and earthy brown, each consisting of calcium salts of bilirubin and other anions, along with an unmeasured residue that is largely mucin glycoproteins. Studies in model systems indicate that the small proportion of unconjugated bilirubin in bile is solubilized by bile salts and that the ionized bilirubin is more soluble than the protonated diacid. Solubility is decreased by added lecithin but is unaffected by cholesterol. At the pH of bile, unconjugated bilirubin exists mainly as a monoanion with sufficient solubility in mixed micelles not to precipitate, were it not for the presence of calcium, which forms highly insoluble salts with unconjugated bilirubin anions.

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“…Bacteria, particularly Escherichia coli, can colonize the bile ducts by entering the portal venous system through the gastrointestinal tracts of debilitated or malnourished patients. 4 Nevertheless, hepatolithiasis is seldom observed in patients from Western populations with cholelithiasis and E. coli infection. Ascaris lumbricoides or Clonorchis sinensis sometimes can be identified in the biliary tracts of Asian populations with hepatolithiasis.…”

Section: Introductionmentioning

confidence: 99%

Relation of hepatolithiasis to helminthic infestation

Huang

Chen

Yen

et al. 2005

J of Gastro and Hepatol

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Helminthiasis is a possible risk factor for hepatolithiasis, although it is unlikely to increase the incidence of complications, including bile duct stricture, secondary biliary cirrhosis, and cholangiocarcinoma. Patients with helminthiasis tend to have a history of an asymptomatic 'lucid interval' between the periods of recurrent abdominal pain in their childhood and the diagnosis of hepatolithiasis in their adulthood.

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Effects of Diet on Glucaric Acid Concentration in Bile and the Formation of Calcium Bilirubinate Gallstones

Cited by 58 publications

References 17 publications

Hepatolithiasis and the Syndrome of Recurrent Pyogenic Cholangitis: Clinical, Radiologic, and Pathologic Features

Hepatolithiasis and the Syndrome of Recurrent Pyogenic Cholangitis: Clinical, Radiologic, and Pathologic Features

The Etiology of Pigment Gallstones

Relation of hepatolithiasis to helminthic infestation

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