Utility of biliary microscopy for the prediction of the chemical composition of gallstones and the outcome of dissolution therapy with ursodeoxycholic acid

Ros, Emilio; Navarro, Salvador; Fernández, Irene; Reixach, María; Ribó, Josep M.; Rodés, Joan

doi:10.1016/0016-5085(86)90642-6

Cited by 54 publications

(7 citation statements)

References 40 publications

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“…They proposed that UDCA may bind calcium ions weakly and increase calcium activity in bile compared to other bile acids. These data well correspond with our present results and may be compatible with the recent reports of gallstone calcification during UDCA therapy (Bateson et al 1981;Raedsch et al 1981;Ros et al 1986). …”

Section: Total and Ionized Calcium Concentrations In Gallbladder Bilesupporting

confidence: 94%

The Effect of Biliary Bile Acid Concentration and Composition on the Calcium Level in Human Gallbladder Bile.

Tamasawa

Yoneda

Makino

et al. 1993

Tohoku J. Exp. Med.

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Section: Total and Ionized Calcium Concentrations In Gallbladder Bilesupporting

confidence: 94%

The Effect of Biliary Bile Acid Concentration and Composition on the Calcium Level in Human Gallbladder Bile.

Tamasawa

Yoneda

Makino

et al. 1993

Tohoku J. Exp. Med.

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“…Pigment stones (renal and ureter stones 55, 40.7%) are composed of Ca bilirubinate, phosphate, and carbonate. The cause of their formation is commonly found in association with hemolysis or cirrhosis (Ros et al 1986;Abu-Farsakh 1997;Fru et al 2004).…”

Section: Discussionmentioning

confidence: 97%

Mineralogy and chemistry of urinary stones: patients from North Jordan

Abboud

2007

Environ Geochem Health

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Urinary stone diseases are increasing in the Middle East. The majority of urinary stone cases are found in the northern part of the country. Stone samples taken from patients living in the Irbid area were collected from Princess Basma Hospital. The present study concentrates on the mineralogical and chemical composition of the urinary stones and on the effective environmental factors that assist in developing the different types of urinary stones. Using X-ray diffraction techniques, the mineralogical composition of the urinary stones was found to be as follows: oxalate, cholesten, and uric acid, with cystine stones occuring more frequently than the others. Cholesten and calcium oxalate stones are the most dominant types of stones. Calcium oxalate is the most common type of oxalate stone. Calcium oxalate is represented in: whewellite, wheddellite, and calcium carbonate oxalate hydrate minerals, in addition to other minerals such as brushite, ammonium phosphate, vaterite, valleriite, and bobierrite from other types of stones. Bobierrite (phosphate group) is a new mineral reported in urinary stones, and this has not been determined in any previous study worldwide. Apatite (calcium phosphate) is deduced using scanning electron microscope (SEM) images. The SEM technique determined crystal forms and systems, shapes, morphological features, and the names of the minerals forming urine stones, while optical properties are studied by polarizing microscope. X-ray fluorescence technique determined the concentrations of major and some trace elements. It revealed that Ca is the main constituent of the urinary stones, especially those composed of calcium oxalate and calcium phosphate. The concentration of trace elements was Ba = 1.57, P = 3.61, Fe = 1.78, S = 2.08, Zr = 4.63, Mo = 3.92, Cu = 1.89, Co = 1.56, and F = 4.2% and was higher in the urinary stones of Jordanian patients than in foreigners in the country. Questionnaires completed by patients suggest that the most significant factors directly effecting the formation of stones are water, climate conditions, food rich in protein and rich in different chemicals. Moreover, some drugs and diseases might also help in developing other stones.

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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%

“…Chronic administration of the cholesterol gallstone ‘dissolving’ bile acids, chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA) [65] was often associated with formation of calcified shells on gallstones [46], and dissolution failure from this cause occurred in 10–15% of subjects [46–50]. As calcification was first described in UDCA‐treated patients, it was postulated that UDCA was most likely precipitating as the calcium salt of its less soluble glycine conjugate [47].…”

Section: Association Of Pigment Cholelithiasis With Enterohepatic Cycmentioning

confidence: 99%

“…In contrast, in vitro studies suggested that glycoursodeoxycholate and glycochenodeoxycholate might actually be protective against calcium precipitation in bile [37,66] by virtue of prolonged metastability of their supersaturated solutions. Chemical analysis of radiolucent gallstones that failed to dissolve with CDCA or UDCA suggested that either calcium bilirubinate [48] or calcium carbonate was deposited on their surfaces [49]. Moreover, CT evaluation [50] of the calcium content of stones that failed to dissolve on oral dissolution therapy revealed signal attenuation consistent with gallstone calcification.…”

Section: Association Of Pigment Cholelithiasis With Enterohepatic Cycmentioning

confidence: 99%

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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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Utility of biliary microscopy for the prediction of the chemical composition of gallstones and the outcome of dissolution therapy with ursodeoxycholic acid

Cited by 54 publications

References 40 publications

The Effect of Biliary Bile Acid Concentration and Composition on the Calcium Level in Human Gallbladder Bile.

The Effect of Biliary Bile Acid Concentration and Composition on the Calcium Level in Human Gallbladder Bile.

Mineralogy and chemistry of urinary stones: patients from North Jordan

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

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