Intervención nutricional en el control de la colelitiasis y la litiasis renal / Nutritional intervention in the control of gallstones and renal lithiasis

La colelitiasis y litiasis renal son patologías frecuentes en países desarrollados. Los cálculos biliares pueden ser pigmentarios, de colesterol (75%) o mixtos. La edad, el sexo femenino, la obesidad, la pérdida rápida de peso, el consumo de azúcares refinados, la grasa saturada, la deficiencia de hierro y de vitamina D y la baja ingesta de fibra y vitamina C son factores asociados a mayor riesgo de colelitiasis. Por otro lado, la ingesta de ácidos grasos ω-3, ácido oleico, calcio, magnesio, fibra, frutas y verduras, lácteos, frutos secos, café, un consumo moderado de alcohol, suplementos de vitamina C, ejercicio físico y una alimentación regular desempeñan un papel protector. Las litiasis renales más frecuentes son de oxalato cálcico, seguidas de las mixtas (oxalato y fosfato cálcico), estruvita, ácido úrico y cistina. Se aconseja una elevada ingesta hídrica (> 2,5 l/día), variando el tipo de alimentos recomendados o desaconsejados en función del tipo de cálculo. En litiasis oxálica se recomienda reducir el consumo de carne, moderar el de espinacas, acelgas, espárragos, chocolate y evitar el aporte excesivo de sodio. La administración de probióticos degradantes de oxalato (Lactobacillus) podría reducir su absorción intestinal, aunque son necesarios más estudios para corroborar estos resultados. En las de fosfato cálcico se aconseja dieta acidificante y limitar el consumo de café y té. La prevención de cálculos de úrico está basada en la hidratación con bebidas alcalinizantes y dieta vegetariana, disminuyendo los alimentos ricos en purinas (hígado, riñón, huevas de pescado, anchoas, sardinas y mariscos), y en cálculos de cistina se aconseja el consumo de dietas alcalinizantes. Dado que la formación de cálculos de estruvita se debe a infecciones urinarias, es necesario un tratamiento farmacológico y el consumo de dietas acidificantes, moderar la ingesta de alimentos ricos en fosfatos y limitar el aporte de grasas y cítricos. La intervención nutricional es una medida eficaz en la prevención de la litiasis biliar y renal y para evitar su recurrencia

Cholelithiasis and kidney stones are frequent pathologies in developed countries. Gallstones can be pigmentary, cholesterol (75%) or mixed. Age, female sex, obesity, rapid weight loss, consumption of refined sugars, saturated fat, iron deficiency, vitamin D and low intake of fiber and vitamin C are factors associated with an increased risk of cholelithiasis. On the other hand, the intake of ω-3 fatty acids, oleic acid, calcium, magnesium, fiber, fruits and vegetables, dairy products, nuts, coffee, moderate consumption of alcohol, vitamin C supplements, physical exercise and a regular diet have a protective paper. The most frequent kidney stones are calcium oxalate followed by mixed ones (oxalate and calcium phosphate), struvite, uric acid and cystine. A high water intake is recommended (> 2.5 l / day), varying the type of recommended or unadvisable food depending on the type of calculus. In oxalic lithiasis it is recommended to reduce the consumption of meat, moderate that of spinach, Swiss chard, asparagus, chocolate and avoid excessive sodium intake. The administration of oxalate-degrading probiotics (Lactobacillus) may reduce intestinal absorption, although further studies are necessary to corroborate these results. In calcium phosphate acidifying diet is recommended and limit the consumption of coffee and tea. The prevention of uric calculus is based on hydration with alkalizing drinks and vegetarian diet, decreasing foods rich in purines (liver, kidney, fish eggs, anchovies, sardines and seafood) and in calculus of cystine diet is recommended alkalizing. Since the formation of struvite calculi is due to urinary infections, pharmacological treatment and the consumption of acidifying diets, moderation of the intake of phosphate-rich foods and limiting the contribution of fats and citrus fruits are necessary. The nutritional intervention is an effective measure in the prevention of biliary and renal lithiasis and prevent its recurrence

Management of symptomatic cholelithiasis while on ketogenic diet: a case report.

INTRODUCTION: The ketogenic diet is a treatment modality used for patients with refractory epilepsy. Development of cholelithiasis while on the ketogenic diet is a potential side effect that has been described in the literature. There however have not been any reports on the outcomes of continuing the diet after cholecystectomy. PATIENT: We present a 5-year-old boy with history of pharmacologically intractable epilepsy that was well controlled on the ketogenic diet. He underwent laparoscopic cholecystectomy for the development of symptomatic cholelithiasis 12 months after the initiation of ketogenic diet for seizure control. RESULTS: Patient tolerated the surgery well and was able to continue the ketogenic diet postoperatively. DISCUSSION: There have been no reports describing the continuation of ketogenic diet after cholecystectomy. This child demonstrates the safety of the procedure and the ability to continue the ketogenic diet without further biliary or surgical complications.

[Results of early rehabilitation after various methods of cholecystectomy at Ust'-Kachka resort]. / Rezul'taty rannei reabilitatsii posle razlichnykh variantov kholetsistéktomii na kurorte Ust'-Kachka.

Early rehabilitation after open cholecystectomy or cholecystectomy from a mini-approach was performed in 101 patients with cholelithiasis treated surgically at Ust-Kachka health resort. Changes in clinico-laboratory indices reflecting the condition of hepatopancreatobiliary system and central hemodynamics before and after rehabilitation were studied depending on the variant of cholecystectomy. Advantages of early rehabilitation of patients after different variants of cholecystectomy at Ust-Kachka health resort in normalization of general condition of the patients and in prevention of functional disorders progression early after operation are demonstrated.

Phosphatidylcholine-enriched diet prevents gallstone formation in mice susceptible to cholelithiasis.

Cholesterol gallstones affect approximately 10-15% of the adult population in North America. Phosphatidylcholine (PC) is considered to be the main cholesterol solubilizer in bile. This study examined the effect of a PC-enriched diet on gallstone incidence in mice susceptible to cholelithiasis. The result obtained showed that the feeding of a lithogenic (LG) diet for 4 weeks or 8 weeks resulted in cholesterol gallstone incidences of 47% and 89%, respectively. These gallstone incidences were either reduced or prevented when the LG diet was enriched with 2% or 6% PC, respectively. The cholesterol saturation index (CSI) was reduced only in mice fed with LG + 6% PC diet as compared with mice fed the LG diet alone. However, in all groups, the CSI was significantly higher than in mice fed Purina chow diet. The biliary anionic polypeptide fraction (APF) was significantly increased in mice fed the LG + 2% PC diet and was reduced in those fed with LG + 6% PC diet. In conclusion, prevention or delay of gallstone formation was not due to a consistent effect on biliary lipid composition, suggesting a direct effect of PC on cholesterol solubilization and/or the effect of an additional nonlipid biliary component such as APF.

The management of nonpigmented gallstones in children.

BACKGROUND/PURPOSE: An increasing number of children are diagnosed with gallstones today. The best management of nonpigmented gallstones in children without hematologic disorders is not known. METHODS: The authors prospectively studied 74 children with cholelithiasis diagnosed with ultrasonography. Clinical presentation, natural history, complications, and indications for cholecystectomy were examined. The follow-up (mean, 21 months) consisted of routine clinic visits, chart reviews, and telephone questionnaires with the children or their parents. RESULTS: Of the 74 children, 33 required cholecystectomies, and 41 were followed. The average age was similar in the 2 groups (11.7 v 11.0 years). Children with risk factors for cholelithiasis required earlier surgical treatment (P < .001). In the operative group, 8 presented acutely and 25 electively. There were 2 complications, a wound infection and a retained common duct stone. In the group that underwent follow-up, 34 of 41 children remained asymptomatic or had symptoms improve with dietary manipulation. No complications developed during the follow-up period. CONCLUSIONS: Children with gallstones and typical symptoms of right upper quadrant or epigastric pain with food intolerance should undergo cholecystectomy. Eighty-two percent of children with cholelithiasis and atypical symptoms had improvement with dietary manipulation. Pediatric patients with gallstones that are asymptomatic or associated with atypical symptoms can be safely followed without complications.

[The influence of the relieving-dietetic therapy on the calculi acoustic properties in biliary calculous disease]. / Vplyv rozvantazhuval'no-diietychnoï terapiï na akustychni vlastyvosti konkrementiv pry zhovchnokam'ianii khvoroby.

In 45 patients with biliary calculous disease the relieving-dietetic therapy course was performed. The fragmentation or lysis of echopermeable echononsolid, echononpermeable echononsolid, echopermeable echosolid calculi was established. There was not noted fragmentation of echononpermeable echosolid calculi.

Cholecystokinin increases bile acid synthesis with total parenteral nutrition but does not prevent stone formation.

Total parenteral nutrition (TPN) is associated with cholestasis and gallstones. Gallbladder stasis may be important in the development of gallstones, and cholecystokinin (CCK) to stimulate gallbladder contraction has been proposed as a treatment to prevent this complication. We studied in vivo bile acid synthesis and bile acid output in miniswine on TPN to test whether daily CCK improves bile acid output and normalizes bile acid profiles with TPN. Nine miniswine were nutritionally maintained with TPN for 4 weeks; four pigs received CCK (0.1 mg/kg) iv daily. In vivo bile acid synthesis was measured with injection of 7 alpha-tritiated cholesterol. An increase in tritiated water reflects the activity of 7 alpha-hydroxylation, the rate-limiting step in bile acid synthesis. At the end of 4 weeks, bile was collected and bile acid output and bile salt profiles were determined. One of five animals on TPN developed gallstones while two of four receiving daily CCK developed stones. In vivo bile acid synthesis decreased with TPN (controls, 63 +/- 9 mg/24 hr versus TPN, 13 +/- 4 mg/24 hr) and increased in TPN animals with CCK treatment (TPN-CCK, 105 +/- 35 mg/24 hr). Bile acid profiles are changed with TPN with more secondary bile acids, this was not improved with CCK. CCK improved bile acid synthesis and bile acid output but failed to prevent gallstone formation or normalize bile salt profiles. In addition to promoting gallbladder contraction, CCK may have a stimulatory effect on bile acid synthesis. CCK alone did not prevent gallstone formation.

[Rationales for the selection of the therapies for gallstones].

Surgical cholecystectomy used to be the only definitive method of gallstone treatment. Recently, however, there have been greatly advancing in the therapies for gallstones, which comprise oral or topical litholysis, lithotripsies with shock wave or endoscopical techniques, and laparoscopical cholecystectomy. Some factors must be considered in selecting the method for the treatment of gallstones, such as; well-understanding of the physiology and the pathophysiology of gallbladder (stones), precise US tomography, the effects of diet, and especially the patient's performance status, patient's profile and informed consent.

[The effect of soy bran on the bile acid spectrum of patients with cholelithiasis]. / Vliianie soevykh otrubei na spektr zhelchnykh kislot bol'nykh zhelchnokamennoi bolezn'iu.

Thirty females aged 21-57 with cholelithiasis in the physicochemical stage were put on a diet including soya bran. Bile acids were assayed in the duodenal portion B by gas-liquid chromatography. A pre- and posttreatment bile spectrum analysis indicated that before the dietetics chenodeoxycholic acid concentration and mean total of bile acids were markedly lower than control values. The diet enriched with food fibers promoted normalization of the above parameters.

Dietary fat and fatty acids modulate cholesterol cholelithiasis in the hamster.

We tested two hypotheses, i) whether the type and the amount of fat in the diet will affect the formation of cholesterol gallstones in the hamsters, and ii) whether palmitic acid, a major fatty acid component of butterfat, can act as a potentiator of cholesterol cholelithiasis in the hamster. Young, male golden Syrian hamsters (Sasco) were fed a semipurified diet containing casein, corn starch, cellulose and cholesterol (0.3%) to which various types and amounts of fat (butterfat, olive oil, menhaden oil, corn oil) were added. All diets contained 2% corn oil to supply essential fatty acids to the growing hamsters. No deaths or illness occurred during the experiment. Animals fed the semipurified diet plus 4% butterfat (group 1) had a gallstone incidence of 63%. Replacement of butterfat with either olive oil, corn oil or menhaden oil prevented the formation of cholesterol gallstones entirely (groups 2-4). When total butterfat was increased from 4% to 8% (group 8), the incidence of cholesterol gallstones increased to 80%. Substitution of 4% olive oil (group 5), corn oil (group 6), or menhaden oil (group 7) for the additional 4% butterfat significantly reduced gallstones to 35%, 45% and 30%, respectively. The replacement of 4% butterfat with 1.2% palmitic acid gave the highest incidence of cholesterol gallstones (95%). These results suggest that butterfat (and one of its components, palmitic acid) intensifies gallstone formation in this model whereas mono- and polyunsaturated fats act as inhibitors of cholesterol cholelithiasis. A fatty acid, possibly palmitic acid, appears to act as lithogen in our model.

[The effect of a diet enriched with food fibers and polyunsaturated fatty acids on the composition of the lipid components in the enterohepatic circulation system in rabbits with cholestasis]. / Vliianie ratsiona, obogashchennogo pishchevymi voloknami i polinenasyshchennymi zhirnymi kislotami, na sostav lipidnykh komponentov v sisteme pechenochno-kishechnoi tsirkuliatsii u krolikov pri kholestaze.

In experiments on rabbits that had undergone partial constriction of the choledochus, the development of calculous hepatocholecystitis was observed in a half of the operated on animals. No biliary calculi were detected in the animals that received the ration enriched with food vegetable fibres, beta-sitosterol and linoleic polyunsaturated fatty acids after similar operations.

Disolución química de cálculos biliares con mentol / Chemical dissolution of bile duct stones with menthol

Se realizó un estudio experimental en 18 cánidos, en 11 de los cuales se administró aciete de girasol con mentol al 20% a través de colecistostomía y en siete controles se usó aciete de girasol puro, durante dos semanas. Se observaron mínimas alteraciones en la pruebas de funcionamiento hepático con el grupo de estudio (p>0.05), no hubo alteraciones morfológicas del hígado, fueron mínimas en vescícula y colédoco en ambos grupos y el mentol no favoreció el desarrollo bacteriano. Concluimos que el mentol en aceite puede emplearse en humanos con litiasis residual a través de la sonda en T. De cinco enfermos con este tratamiento, se logró la disolución química de los cálculos biliares en tres y disolución de un cálculo y diminución del tamaño de otro en un enfermo más, con mínimos efectos colaterales.

[The necessity for intragroup individualization of diet No. 5 in hepatobiliary diseases]. / Vurkhu neobkhodimostta ot vutregrupovo individualizirane na dieta No. 5 pri chernodrobno-zhluchnite zaboliavaniia.

The frequency of cholelithiasis in Bulgaria has increased 9 times for the last 15 years. At the same time 40.5% of the patients with cholelithiasis are obese--II-IV degree of obesity. This fact calls for individualization of diet No 5 which in this country is applied to patients with liver and biliary diseases. A variant diet No 5-x for patients with cholelithiasis and abnormal body mass is proposed. This diet keeps the protein and fat components of diet No 5 but reduces the carbohydrates quantity from 346 g to 195-200 g which leads to the reduction of the daily intake of calories from 2369-2450 to 1700. The individualization of diet No 5 and the introduction of diet No 5-x in patients with biliary diseases will ensure a greater prophylactic and therapeutic efficacy of the dietetic treatment of patients with cholelithiasis and other biliary diseases combined with various degree of obesity.