How Many Americans Will Be Eligible for Biliary Lithotripsy?

Magnuson, Thomas; Lillemoe, Keith D.; Pitt, Henry A.

doi:10.1001/archsurg.1989.01410100097017

Cited by 30 publications

(5 citation statements)

References 21 publications

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“…25 Furthermore, secondary calcification has been reported in 9-21% of patients with cholesterol-rich stones, 21 and is a function of both stone size (large gall-bladder stones are more likely to be calcified than small stones) and stone age. 26,27 In the few small reports of the chemical composition of stones obtained at cholecystectomy from patients with Crohn's disease, both pigment stones 12,28 and cholesterol-rich stones 10,12 have been reported. Our findings of altered bile acid composition in Crohn's disease are consistent with those of previous studies, which have reported reduced active bile acid absorption in the diseased or resected terminal ileum and a reduction in the bile acid pool within the enterohepatic circulation.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, secondary calcification has been reported in 9–21% of patients with cholesterol‐rich stones, 21 and is a function of both stone size (large gall‐bladder stones are more likely to be calcified than small stones) and stone age 26 ,. 27 In the few small reports of the chemical composition of stones obtained at cholecystectomy from patients with Crohn's disease, both pigment stones 12 , 28 and cholesterol‐rich stones 10 , 12 have been reported.…”

Section: Discussionmentioning

confidence: 99%

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Bile composition in inflammatory bowel disease: ileal disease and colectomy, but not colitis, induce lithogenic bile

Pereira

Bain

Kumar

et al. 2003

Aliment Pharmacol Ther

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SUMMARYBackground: Inflammatory bowel disease is a risk factor for gall-bladder stones, but there is controversy about the composition of these stones and whether such patients develop lithogenic bile. Methods: In 54 gallstone-free inflammatory bowel disease patients and 13 non-inflammatory bowel disease patients with cholesterol-rich gallstones, we measured the biliary cholesterol saturation indices, nucleation times and bilirubin concentrations, and determined the bile acid composition and molecular species of phosphatidylcholine, in gall-bladder bile. Results: Patients with Crohn's colitis or ulcerative colitis had less saturated bile (mean cholesterol saturation index, 0.9) and longer nucleation times (median,

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bile composition in inflammatory bowel disease: ileal disease and colectomy, but not colitis, induce lithogenic bile

Pereira

Bain

Kumar

et al. 2003

Aliment Pharmacol Ther

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“…Several lines of evidence support the proposal that ‘black’ pigment gallstones can be caused by an acquired EHC of bilirubin. Increased prevalence of black pigment cholelithiasis is known to occur in Crohn's disease [5,42,43], ileal resection [5,44] or bypass [45], oral bile acid administration [46–50], high cholesterol [51,52] and carbohydrate‐containing diets [53], total parenteral nutrition [54,55], alcoholism [56] and cystic fibrosis [57]. We show now that the common denominator in all of these appears to be hyperbilirubinbilia caused by bile salt malabsorption with resorption of UCB from the distal small and large intestines (Table 2).…”

Section: Association Of Pigment Cholelithiasis With Enterohepatic Cycmentioning

confidence: 99%

“…Plain radiographs of the abdomen revealed that 57% of patients carried radioopaque calculi compared with 18% in the control group, suggesting a higher prevalence of noncholesterol stones in patients with ileal dysfunction [42]. Magnuson and colleagues [44] verified by chemical analysis that calcium bilirubinate was the principal component of gallstones in Crohn's disease, and Dawes and colleagues [63] were the first to demonstrate that patients with Crohn's disease exhibited significantly increased levels of monoconjugated and unconjugated bilirubins in their gallbladder biles. These findings were confirmed [5] and enrichment of gallbladder bile with bile pigments was most pronounced in patients with Crohn's disease who had had an ileectomy.…”

Section: Association Of Pigment Cholelithiasis With Enterohepatic Cycmentioning

confidence: 99%

Enterohepatic cycling of bilirubin as a cause of ‘black’ pigment gallstones in adult life

Vı́tek

Carey

2003

Eur J Clin Investigation

100

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In contrast to bile salts, which undergo a highly efficient enterohepatic circulation with multiple regulatory and physiologic functions, glucuronic acid conjugates of bilirubin are biliary excretory molecules that in health do not have a continuing biologic life.Intestinal absorptive cells are devoid of recapture transporters for bilirubin conjugates, and their large size and polarity prevent absorption by passive diffusion. However, unconjugated bilirubin, the β -glucuronidase hydrolysis product of bilirubin glucuronides can be absorbed passively from any part of the small and large intestines. This can occur only if unconjugated bilirubin is kept in solution and does not undergo rapid bacterial reduction to form urobilinoids. Here we collect, and in some cases reinterpret, experimental and clinical evidence to show that in addition to the well-known occurrence in newborns, enterohepatic cycling of unconjugated bilirubin can reappear in adult life. This happens as a result of several common conditions, particularly associated with bile salt leakage from the small intestine, the most notable ileal dysfunction resulting from any medical or surgical cause. We propose that when present in excess, colonic bile salts solubilize unconjugated bilirubin, delay urobilinoid formation, prevent calcium complexing of unconjugated bilirubin and promote passive absorption of unconjugated bilirubin from the large intestine. Following uptake, reconjugation, and resecretion into bile, this source of 'hyperbilirubinbilia' may be the important pathophysiological risk factor for 'black' pigment gallstone formation in predisposed adult humans.

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“…In the United States and at Johns Hopkins, approximately 75% of patients having cholecystectomy for chronic cholecystitis have cholesterol gallstones. 4 Similarly, most patients with gallstones in Chile have cholesterol stones and so do Chilean patients with gallbladder cancer (H.A. Pitt, unpublished data, 2002).…”

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confidence: 99%