Free fatty acids and triglyceride change in the gallbladder bile of gallstone patients with pancreaticobiliary reflux

Abstract

Background Pancreaticobiliary reflux (PBR) causes chronic inflammation of the gallbladder mucosa and changes in the bile components, which are known to promote gallstone formation. This study aimed to investigate the bile biochemistry changes in gallstone patients with PBR and provide new clues for research on the involvement of PBR in gallstone formation. Methods Patients undergoing surgery for gallstones between December 2020 and May 2021 were eligible for inclusion. The bile biochemistry (including amylase, lipase, triglyceride, cholesterol, free fatty acids [FFAs], alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], and γ-glutamyl transferase [γ-GT]) of the included gallstone patients was analysed to determine correlations with PBR. Results In this study, 144 gallstone patients who underwent surgery were enrolled. Overall, 15.97 % of the patients had an increased bile amylase level, which was associated with older age and significantly higher bile levels of ALP, lipase, triglyceride, and FFAs. Positive correlations were observed between amylase and lipase, triglyceride, FFAs levels in the gallbladder bile. However, the bile levels of triglyceride, FFAs, and lipase were positively correlated with each other only in the PBR group and showed no significant correlation in the control (N) group. In addition, elevated bile FFAs levels were found to be an independent risk factor for gallbladder wall thickening. Conclusions In conclusion, PBR-induced increase in FFAs and triglyceride in the gallbladder bile is a cause of gallstone formation, and an increase in bile ALP suggests the presence of cholestasis in PBR.

Identification of changes in bile composition in pancreaticobiliary reflux based on liquid chromatography/mass spectrometry metabolomics

“…All these factors play a positive role in gallstone formation [ 38 ]. Previous study showed that the total FFA content in the bile of patients with PBR was significantly higher than that in the control group [ 39 ]. Interestingly, here we found that palmitic acid increased significantly in patients with PBR, which might play an active role in gallstone formation.…”

Features of Metabolite Changes in Disease Evolution in Cholecystolithiasis

“…In bile, the presence of FFA has been demonstrated [ 33 , 34 ]. The elevated levels of bile FFAs were found to be an important and main risk factor for gallbladder wall thickening process [ 35 ]. FFAs are well-known risk factors of cardiovascular diseases (CVDs) [ 36 ] and have closely relationship with the events of metabolic syndromes (MetS), such as obesity and type 2 diabetes mellitus (T2DM).…”

Bile Composition - which Components Can Have Clinical Significance? A Review of the Literature

“…Compared to the bile of controls, the bile from patients with gallstones had higher total free fatty acid content, more palmitic acid, more stearic acid, more linoleic acid and arachidonic acid [41]. Xiang et al [42] suggest that pancreaticobiliary reflux induced an increase in FFAs and triglycerides in the gallbladder bile is a cause of gallstone formation.…”