Pancreaticobiliary Reflux in Patients with and without Cholelithiasis: Is It a Normal Phenomenon?

Abstract

Pancreaticobiliary reflux is a common phenomenon in patients with gallstones and an uncommon phenomenon in patients with healthy gallbladders without gallstone disease.

Common Bile Duct Stones Associated with Pancreatobiliary Reflux and Disproportionate Bile Duct Dilatation

“…[14] In contrast, others suggested that reflux of pancreatic juice causes chronic inflammation of the gallbladder, which subsequently results in gallstone formation. [5,8,13,15,16] Although, it is unclear whether the stones causes PBR or vice versa, our observation of PBR in patients with acute calculous cholangitis is compatible with the results of others that conducted studies on occult PBR in patients with a normal pancreatobiliary junction. [6,14] However, there is still no definitive knowledge of exactly what this occult PBR means clinically.…”

“…[6,8,13,14] Some researchers hypothesized that papillitis due to stones causes dysfunction of the sphincter of Oddi, which then leads to reflux of pancreatic juice. [14] In contrast, others suggested that reflux of pancreatic juice causes chronic inflammation of the gallbladder, which subsequently results in gallstone formation.…”

“…[8,10,13,26] Vracko and Wiechel [27] divided 63 patients with gallstones into a group with and a group without bile duct stones. They found that trypsin, a marker of pancreatic juice reflux, was increased within the gall bladder and that the width of the cystic duct was increased in the group with bile duct stones.…”

Many faces of pancreaticobiliary reflux

“…prospectively compared gall bladder amylase levels during cholecystectomy in patients with and without gallstones. They found that amylase levels were elevated in 83.5% of patients with gallstones compared with only 6% of patients with normal gall bladders ( P < 0.0001) 20 . In a 2011 editorial by the same author, PBR is thus proposed as an important underlying aetiological factor in gallstone formation 21 .…”

“…It is associated with a variety of benign and malignant diseases of the biliary tract including CCs and pancreatitis (cases 1, 2), cholelithiasis (cases 3, 4), as well as choledocholithiasis, cholecystitis and biliary malignancy 8 . PBR has been found experimentally in a minority of patients without biliary disease, 20 and may also occur in the absence of a long common channel (case 4). If the diagnosis of PBR (without associated CC) is made during any intervention other than a cholecystectomy, we recommend subsequent prophylactic cholecystectomy because of the increased risk of gall bladder carcinoma.…”