The effect of cholecystectomy on bile salt metabolism

Pomare, E W; Heaton, K W

doi:10.1136/gut.14.10.753

Cited by 185 publications

(79 citation statements)

References 23 publications

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“…Such high ratios have been reported for gallstone patients with nonvisualizing gallbladder in one (5) but not another study (43), for cholecystectomized gallstone patients in some (41,44) but not other studies (21,45), and for some conditions with a high risk of gallstone formation such as partial resection of the ileum (46) or hyperlipidemia type Ilb or IV (47).…”

Section: Discussionmentioning

confidence: 88%

Disorders of bile acid metabolism in cholesterol gallstone disease.

Berr

Pratschke²,

Fischer³

et al. 1992

J. Clin. Invest.

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The aim of the study was to evaluate the metabolism of individual bile acids in patients with cholesterol gallstone disease. Therefore, we determined pool size and turnover of deoxycholic (DCA), cholic (CA), and chenodeoxycholic acid (CDCA) in 23 female gallstone patients classified according to their gallbladder function and in 15 healthy female controls. Gallstone patients had normal hepatic bile acid synthesis, but, depending on gallbladder function, differed with respect to turnover and size of the bile acid pools: Patients with well-emptying gallbladder (group A, n = 9) had enhanced turnover and reduced pools of CA (-46%; P < 0.01 vs. controls) and CDCA (-24%; P < 0.05), but normal input and size of the DCA pool. With reduced gallbladder emptying (< 50% of volume; group B, n = 6), turnover and pools of CA, CDCA, and DCA were similar as in controls. Patients with loss ofgallbladder reservoir (group C, n = 8) had increased input (+100%; P < 0.01) and pool size of DCA (+45%; P = 0.07) caused by rapid conversion of CA to DCA, while the pools of CA (-71%; P < 0.001 vs. controls) and CDCA (-36%; P < 0.05) were reduced by enhanced turnover. Thus, in patients with cholesterol gallstones, the pools of primary bile acids are diminished, unless gallbladder emptying is reduced. Furthermore, in a subgroup of gallstone patients, who had completely lost gallbladder function, the CA pool is largely replaced by DCA owing to rapid transfer of CA to the DCA pool. This probably contributes to supersaturation of bile with cholesterol. (J. Clin. Invest. 1992. 90:859-868.) Key words: bile acid metabolism * cholesterol gallstone disease * deoxycholic acid -gallbladder emptying . cholesterol saturation of bile IntroductionIn most nonobese patients with cholesterol gallstones, the pools of cholic acid (CA)' and chenodeoxycholic (CDCA) are reduced ( 1-6), and deoxycholic acid (DCA) is often increased in bile (7). Both changes could contribute to supersaturation of bile with cholesterol ( 1, 7, 1. Abbreviations used in this paper: CA, cholic acid; CCK, cholecystokinin; CDCA, chenodeoxycholic acid; DCA, deoxycholic acid; FTR, fractional turnover rate. circulation (9), the increase ofDCA by raising biliary secretion of cholesterol ( 10).The small pools ofCA and CDCA may be caused by a small gallbladder reservoir ( 1 1), by enhanced turnover (2, 5), or by inhibition of bile acid synthesis by an oversensitive feedback mechanism ( 1 2) or by elevated levels of DCA ( 13,14). An increased fraction ofDCA in bile could be caused by high input and large pool size of DCA. CA is nearly completely 7a-dehydroxylated to DCA by anaerobic bacteria in the colon (7,15,16), but only 30-40% of this DCA is absorbed from the intestine ( 17 ). The DCA pool could be expanded by increased input of DCA owing to increased synthesis ofthe precursor CA or to an increased fraction of CA transferred to the DCA pool.It is still unclear which of the above factors account(s) for the reduction in CA and CDCA pool size and which for an increase in biliary DCA. ...

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Section: Discussionmentioning

confidence: 88%

Disorders of bile acid metabolism in cholesterol gallstone disease.

Berr

Pratschke²,

Fischer³

et al. 1992

J. Clin. Invest.

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“…42 A causal association has been supported by the mechanisms after cholecystectomy, which include a continuous bile flow into the bowel. 43,44 The predilection of the right-side colon has been suggested through a greater proximal colonic absorption of fecal secondary bile acids, 15 which have been considered carcinogenic for a long time. 45,46 An altered activity of colonic microbiota after cholecystectomy, including an increased bacterial degradation of bile acids into fecal secondary bile acids has also been suggested.…”

Section: Discussionmentioning

confidence: 99%

Association Between Screen-Detected Gallstone Disease and Cancer in a Cohort Study

2017

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“…(26 -28) Cholecystectomy results in increased fecal excretion of secondary bile acids due to an increase in the bile acid pool in the enterohepatic circulation and increased degradation of primary bile acids. (29,30) Low concentrations of serum total or LDL cholesterol have been related to increased risk of colon cancer in many prospective studies. (31) Whereas this inverse association has generally been ascribed to the effect of preclinical cancer existing at the baseline, (31) an increased risk of proximal colon cancer associated with low cholesterol levels persisted 10-20 years later in a prospective study of Japanese people in Hawaii.…”

Section: Discussionmentioning

confidence: 99%

Genetic polymorphism of cholesterol 7α‐hydroxylase (CYP7A1) and colorectal adenomas: Self Defense Forces Health Study

et al. 2006

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Bile acids have long been implicated in colorectal carcinogenesis, but epidemiological evidence is limited. Cholesterol 7α α α α-hydroxylase (CYP7A1) is the rate-limiting enzyme producing bile acids from cholesterol. A recent case-control study showed a decreased risk of proximal colon cancer associated with the CC genotype of the CYP7A1 A-203C polymorphism. The present study examined the relationship between the CYP7A1 A-203C polymorphism and colorectal adenoma, which is a well-established precursor lesion of colorectal cancer. The study subjects comprised 446 cases of colorectal adenomas and 914 controls of normal total colonoscopy among men receiving a preretirement health examination at two hospitals of the Self Defense Forces (SDF). The CYP7A1 genotype was determined by the polymerase chain reaction-restriction fragment length polymorphism method. Statistical adjustment was made for age, hospital, rank in the SDF, smoking, alcohol use, body mass index, physical activity and parental history of colorectal cancer. The CYP7A1 polymorphism was not measurably related to the overall risk of colorectal adenomas. However, the CC genotype was associated with a decreased risk of proximal colon adenomas, but not of distal colon and rectal adenomas.

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The effect of cholecystectomy on bile salt metabolism

Cited by 185 publications

References 23 publications

Disorders of bile acid metabolism in cholesterol gallstone disease.

Disorders of bile acid metabolism in cholesterol gallstone disease.

Association Between Screen-Detected Gallstone Disease and Cancer in a Cohort Study

Genetic polymorphism of cholesterol 7α‐hydroxylase (CYP7A1) and colorectal adenomas: Self Defense Forces Health Study

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