Ursodeoxycholic acid combined with percutaneous transhepatic balloon dilation for management of gallstones after elimination of common bile duct stones.

AIM: To evaluate the effectiveness and safety of combined ursodeoxycholic acid and percutaneous transhepatic balloon dilation for management of gallstones after expulsion of common bile duct (CBD) stones. METHODS: From April 2014 to May 2016, 15 consecutive patients (6 men and 9 women) aged 45-86 (mean, 69.07 ± 9.91) years suffering from CBD stones associated with gallstones were evaluated. Good gallbladder contraction function was confirmed by type B ultrasonography. Dilation of the CBD and cystic duct was detected. Percutaneous transhepatic balloon dilation of the papilla was performed, ursodeoxycholic acid was administered, and all patients had a high-fat diet. All subjects underwent repeated cholangiography, and percutaneous transhepatic removal was carried out in patients with secondary CBD stones originating from the gallbladder. RESULTS: All patients underwent percutaneous transhepatic balloon dilation with a primary success rate of 100%. The combined therapy was successful in 86.7% of patients with concomitant CBD stones and gallstones. No remaining stones were detected in the gallbladder. Transient adverse events include abdominal pain (n = 1), abdominal distension (n = 1), and fever (n = 1). Complications were treated successfully via nonsurgical management without long-term complications. No procedure-related mortality occurred. CONCLUSION: For patients with concomitant CBD stones and gallstones, after percutaneous transhepatic removal of primary CBD stones, oral ursodeoxycholic acid and a high-fat diet followed by percutaneous transhepatic removal of secondary CBD stones appear to be a feasible and effective option for management of gallstones.

Anti-cholelithogenic potential of dietary spices and their bioactives.

Dietary hypocholesterolemic spices-curcumin (active compound of turmeric (Curcuma longa)) and capsaicin (active compound of red pepper (Capsicum annuum)), the active principles of spices-turmeric (Curcuma longa) and red pepper (Capsicum annuum), fenugreek (Trigonella foenum-graecum) seeds, garlic (Allium sativum), and onion (Allium cepa) are documented to have anti-cholelithogenic property in animal model. These spices prevent the induction of cholesterol gallstones by lithogenic high cholesterol diet and also regress the pre-established cholesterol gallstones, by virtue of their hypolipidemic potential. The antilithogenic influence of these spices is primarily attributable to their hypocholesterolemic effect. Increased cholesterol saturation index, cholesterol:phospholipid ratio and cholesterol:bile acid ratio in the bile caused by the lithogenic diet was countered by these spices. The antilithogenicity of these hypocholesterolemic spices was considered to be due also to their influence on biliary proteins that have pro-nucleating activity and anti-nucleating activity. Investigations on the involvement of biliary proteins in cholesterol crystal nucleation revealed that in an in vitro bile model, low molecular weight biliary proteins of the lithogenic diet fed animals have a pro-nucleating activity. On the contrary, low molecular weight biliary proteins of the animals fed hypocholesterolemic spices along with lithogenic diet showed a potent anti-nucleating activity.

Potentiation of anti-cholelithogenic influence of dietary tender cluster beans (Cyamopsis tetragonoloba) by garlic (Allium sativum) in experimental mice.

BACKGROUND & OBJECTIVES: Dietary fibre-rich tender cluster beans (Cyamopsis tetragonoloba; CB) are known to exert beneficial cholesterol lowering influence. We examined the influence of a combination of dietary tender CB and garlic (Allium sativum) in reducing the cholesterol gallstone formation in mice. METHODS: Cholesterol gallstones were induced in Swiss mice by feeding a high-cholesterol diet (HCD) for 10 wk. Dietary interventions were made with 10 per cent CB and 1 per cent garlic included individually or together along with HCD. A total of 100 mice were divided into five groups of 20 mice each. RESULTS: Dietary CB, garlic and CB+garlic reduced the formation of cholesterol gallstones by 44, 25 and 56 per cent, respectively, lowered cholesterol by 23-48, 16-24, and 24-58 in bile, serum, and liver, respectively. Cholesterol saturation index in bile and cholesterol: phospholipid ratio in circulation and hepatic tissue were significantly lowered by these dietary interventions, with highest beneficial effect from CB+garlic. Activities of hepatic cholesterol metabolizing enzymes were modulated by CB, garlic and CB+garlic. Elevation in lipid peroxides caused by HCD was also countered by these dietary interventions, the combination producing the highest effect. INTERPRETATION & CONCLUSIONS: The results showed that the prevention of experimentally induced formation of cholesterol gallstones by dietary CB and garlic was due to decreased biliary cholesterol secretion and increased cholesterol saturation index. In addition of anti-lithogenic effect, dietary CB and garlic in combination had a beneficial antioxidant effect.

Regression of preestablished cholesterol gallstones by dietary garlic and onion in experimental mice.

We have recently reported the health beneficial potential of dietary garlic and onion in reducing the incidence and severity of cholesterol gallstone (CGS) during its experimental induction in mice. In the current study, the efficacy of dietary garlic and onion in regressing preestablished CGS was investigated in experimental mice. After inducing CGS in mice with a lithogenic diet for 10 weeks, they were maintained on basal diets containing 0.6% dehydrated garlic or 2% dehydrated onion for a further 10 weeks. Dietary garlic and onion, either raw or heat processed, regressed preformed CGS in mice up to 53% to 59%, whereas the regression in the basal control diet group was only 10%. The antilithogenic potency of garlic was decreased by its heat processing, but not in the case of onion. Biliary cholesterol was significantly decreased in garlic- and onion-fed animals. Biliary cholesterol saturation index and hydrophobicity index were significantly lowered by dietary garlic and onion. Serum and liver cholesterol levels were decreased by feeding these spices during post-CGS induction period. Hepatic hydroxymethylglutaryl-coenzyme A reductase activity was increased after feeding garlic and onion, whereas activities of the cholesterol-degrading enzymes cholesterol-7α-hydroxylase and sterol-27-hydroxylase were increased in spice-fed groups. These results indicate that feeding garlic and onion effectively accelerates the regression of preformed CGS by promoting cholesterol desaturation in bile. This observation is significant in the context of evolving dietary intervention strategy to address regression of existing CGS and stopping the possible recurrence.

Nutritional approaches to prevention and treatment of gallstones.

Cholesterol gallstones are among the most common gastrointestinal disorders in Western societies. Individuals with gallstones may experience various gastrointestinal symptoms and are also at risk of developing acute or chronic cholecystitis. Cholecystectomy is the most frequently recommended conventional treatment for symptomatic gallstones. Bile acids (ursodeoxycholic acid or chenodeoxycholic acid) are also used in some cases to dissolve radiolucent stones, but these drugs can cause gastrointestinal side effects and there is a high rate of stone recurrence after treatment is discontinued. Lithotripsy is used in some cases in conjunction with ursodeoxycholic acid for patients who have a single symptomatic non-calcified gallstone. There is evidence that dietary factors influence the risk of developing cholesterol gallstones. Dietary factors that may increase risk include cholesterol, saturated fat, trans fatty acids, refined sugar, and possibly legumes. Obesity is also a risk factor for gallstones. Dietary factors that may prevent the development of gallstones include polyunsaturated fat, monounsaturated fat, fiber, and caffeine. Consuming a vegetarian diet is also associated with decreased risk. In addition, identification and avoidance of allergenic foods frequently relieves symptoms of gallbladder disease, although it does not dissolve gallstones. Nutritional supplements that might help prevent gallstones include vitamin C, soy lecithin, and iron. In addition, a mixture of plant terpenes (Rowachol) has been used with some success to dissolve radiolucent gallstones. The gallbladder flush is a folk remedy said to promote the passage of gallstones. While minimal scientific evidence supports the efficacy of this treatment, anecdotal reports suggest the gallbladder flush may be beneficial for some people.

[Intrahepatic gallstones in patient with alkaptonuria]. / Intrahepatisk galdesten hos en patient med alkaptonuri.

Alkaptonuria is a rare inherited disease with enzyme deficiency in the protein metabolism. The patients accumulate homogentisic acid which leads to symptoms from various body tissues. We describe a patient with recurrent intrahepatic gallstones probably due to such accumulation, and the successful treatment with removal of the stones and a low-protein diet.

Gallstone disease: Microlithiasis and sludge.

'Sludge' is the solid material which results from the slow settling of particles dispersed in a liquid medium. Biliary sludge in the gallbladder can be detected by transabdominal ultrasonography, and the typical echoes derive mainly from pigment precipitates mixed with cholesterol crystals. A portion of biliary sludge contains comparatively large particles (1-3 mm) called microliths, the formation of which is an obligatory intermediate step in the development of all types of gallstone. Microlithiasis and sludge in bile may cause colicky pain, cholecystitis, cholangitis, and acute pancreatitis, and are thus of clinical relevance. In these patients treatment follows the guidelines of symptomatic gallstone disease, and strategies include long-term application of ursodeoxycholic acid, endoscopic papillotomy, or preferably laparoscopic cholecystectomy.

[Optimization of diet therapy in patients with gallstones complicated with obesity and impaired glucose tolerance]. / Ob optimizatsii dietoterapii bol'nykh zhelchnokamennoi bolezn'iu s soputstvuiushchim ozhireniem i narusheniem tolerantnosti k gliukoze.

It was investigated the influence of a diet with lower glycaemic index on clinico-metabolic parameters in obese patients with gallstones and impaired glucose tolerance. The results investigations indicated that the lowering of glycaemic index and the caloric reduction of diet have a beneficial effects on dynamic of parameters of functional status of liver and gallbladder. It was noted the increase of medical effect of diet in correction of obesity and impaired parameters of carbohydrate and lipid metabolism in this patients in process of dietotherapy.

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.