Biliary Microbiota and Bile Acid Composition in Cholelithiasis.

BACKGROUND: A functional interplay between BAs and microbial composition in gut is a well-documented phenomenon. In bile, this phenomenon is far less studied, and with this report, we describe the interactions between the BAs and microbiota in this complex biological matrix. Methodology. Thirty-seven gallstone disease patients of which twenty-one with Opisthorchis felineus infection were enrolled in the study. The bile samples were obtained during laparoscopic cholecystectomy for gallstone disease operative treatment. Common bile acid composition was measured by LC-MS/MS. Gallbladder microbiota were previously analyzed with 16S rRNA gene sequencing on Illumina MiSeq platform. The associations between bile acid composition and microbiota were analyzed. RESULTS: Bile acid signature and Opisthorchis felineus infection status exert influence on beta-diversity of bile microbial community. Direct correlations were found between taurocholic acid, taurochenodeoxycholic acid concentrations, and alpha-diversity of bile microbiota. Taurocholic acid and taurochenodeoxycholic acid both show positive associations with the presence of Chitinophagaceae family, Microbacterium and Lutibacterium genera, and Prevotella intermedia. Also, direct associations were identified for taurocholic acid concentration and the presence of Actinomycetales and Bacteroidales orders, Lautropia genus, Jeotgalicoccus psychrophilus, and Haemophilus parainfluenzae as well as for taurochenodeoxycholic acid and Acetobacteraceae family and Sphingomonas genus. There were no differences in bile acid concentrations between O. felineus-infected and noninfected patients. Conclusions/Significance. Associations between diversity, taxonomic profile of bile microbiota, and bile acid levels were evidenced in patients with cholelithiasis. Increase of taurochenodeoxycholic acid and taurocholic acid concentration correlates with bile microbiota alpha-diversity and appearance of opportunistic pathogens.

Association between eosinophil count and cholelithiasis among a population with Clonorchis sinensis infection in Foshan City, China.

The association between eosinophil count and cholelithiasis among people with Clonorchis sinensis infection is still uncertain. We conducted a cross-sectional study to investigate the associations among Clonorchis sinensis infection, eosinophil count and cholelithiasis. The study included 4628 participants from January to December 2018. The levels of eosinophil count were divided into four groups according to the quartiles of eosinophil count. Spearman's rank correlation was performed to assess the association between eosinophil counts and Clonorchis sinensis egg counts. Multiple regression analysis was performed to evaluate the relationships among C. sinensis infection, eosinophil count and cholelithiasis after adjusting for three models. The prevalence of C. sinensis infection was 38.72% (1792/4628), and the prevalence of cholelithiasis was 6.03% (279/4628). The infection rate of C. sinensis was higher in the cholelithiasis group than in the non-cholelithiasis group (63.08% vs. 37.16%, P < 0.001). Significant differences were found among various eosinophil count quartiles for C. sinensis infection, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyltranspeptidase (γ-GT), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine (CRE), blood urea nitrogen (BUN), uric acid (UA) and non-alcoholic fatty liver disease (NAFLD) (all P < 0.001). A significant positive correlation was found between eosinophil count and log-transformed C. sinensis egg count (r = 0.9477, P < 0.001). Multiple logistic regression analysis revealed that light and moderate intensities of C. sinensis infection were associated with cholelithiasis (P < 0.01 and P < 0.001, respectively), and C. sinensis infection with eosinophil count ranging from 0.05 to 0.5 × 109/l were associated with cholelithiasis (P < 0.05). In conclusion, our findings suggest that the light and moderate infections of C. sinensis with eosinophil count ranging from 0.05 to 0.5 × 109/l may be associated with a higher risk of cholelithiasis.

Liver flukes promote cholelithiasis in sheep.

The main objective of this study was to investigate whether cholelithiasis in sheep is related to parasitism or other commonly observed disorders such as liver abscesses. Additionally, the features of the observed biliary calculi are described. The livers of 254 randomly selected clinically healthy adult dairy sheep were used. All visible concretions in the bile were considered as stones. Based on the macroscopical examination, 60 livers were normal, 40 were parasitized with Fasciola hepatica, 42 were parasitized with Dicrocoelium dendriticum, 28 were parasitized with both D. dendriticum and F. hepatica, 40 livers had abscesses and 44 had hydatid cysts. Biliary calculi were detected in 40 livers. Twenty livers had pigment stones and 20 livers had cholesterol stones. The percentage of cholelithiasis was significantly higher in livers parasitized with flukes compared with the others (P<0.05) and the parasitoses with F. hepatica and D. dendriticum were proven to be significant risk factors (P<0.05) for the presence of cholelithiasis in sheep.

[Parasitic gallbladder infection]. / Parasitaer galdevejsinfektion.

In two cases of cholecystectomy for gall bladder calculi, the histological diagnoses were inflammation, fibrosis, and numerous calcified parasite eggs in the wall of the gall bladder, compatible with eggs from the liver fluke, which can infect humans who eat raw or undercooked fresh water fish (sushi!).

Right hepatic segmentectomy for the treatment of intrahepatic biliary stones due to ascaris lumbricoides: report of a case.

We report herein the case of a 46-year-old woman investigated for recurrent acute cholangitis. Ultrasound, endoscopic retrograde cholangiopancreatography, and computed tomography scan revealed dilatation and multiple images suggestive of intrahepatic biliary stones in the ducts that drained segments V and VI of the liver. Endoscopic treatment was attempted unsuccessfully, and based on the severity of the last crisis of cholangitis a laparotomy was performed. A right hepatic lobectomy including segments V and VI was carried out without any complications, resulting in complete relief of symptoms. Pathological examination of the liver demonstrated the presence of worm nests in the liver parenchyma with chronic granulomatous lesions.

Hepatolithiasis and biliary parasites.

Hepatolithiasis, or the presence of intrahepatic stones, is prevalent in East Asia and is characterized by the finding of stones within the intrahepatic bile ducts proximal to the confluence of the right and left hepatic ducts. Bile stasis and bacterial infection have been incriminated as the major aetiopathogenic factors. Clinical features include recurrent pyogenic cholangitis, multiple liver abscesses, secondary biliary cirrhosis and cholangiocarcinoma. The goals of management include accurate localization of pathologies, control of biliary sepsis and the elimination of stones and stasis. Ultrasonography, computed tomography and direct cholangiography complement each other in defining the stones, strictures and degree of liver damage. Non-operative biliary decompression by endoscopy and interventional radiology is effective in controlling the infection, but surgery remains the mainstay for the treatment of stones and strictures. Intra-operative ultrasound and flexible choledochoscopy, combined with percutaneous transhepatic cholangioscopy and intraductal lithotripsy, facilitate stone removal. Balloon dilatation and biliary stenting serve to open the bile duct strictures. The creation of a hepaticocutaneous jejunostomy after conventional surgery allows atraumatic access to the biliary system for the removal of recurrent stones. The management of biliary parasites begins with conservative measures, including analgesics and anti-helminthic therapy. In refractory cases or patients with acute cholangitis, endoscopic biliary drainage and the extraction of worms may be necessary. Improvement in sanitation plays a crucial role in the epidemiological control of these biliary diseases.

[The trend of the gallstone disease in China over the past decade].

The present study is the second national survey on 3911 srugically treated cases of gallstones which was collected from 33 hospitals of 5 provinces and 2 main cities of China and aims at reevaluating and comparing the trend of the gallstone disease in China since the first national survey was completed 10 years ago. The results showed that cholelithiasis remained one of the commonest surgical diseases and accounted for 11.5% of overall hospitalized patients during the same period of time and it occurred mostly in females of over 50 years of age, with a female-male ratio of 2.57 Vs 1.80% of the patients with single positioned gallstones had their stones in gallbladder and was mainly cholesterol stone in nature while pigmented bile duct stones was found only in 10% of the patients, which made the gallbladder Vs bile duct stone ratio and the cholesterol Vs pigment stone ratio a significant difference as 7.36 : 1 and 3.4 : 1 respectively when compared with the results of 1.5 : 1 and 3.4 : 1 from the first national survey, 10 years ago. A significantly decreased incidence of biliary ascariasis and biliary bacterial infection rate as well as the dietary changes from low protein, fat high vegetable to the opposite were directly relevant to the above alterations on the location and the type of the gallstones.

Schistosomal cholecystitis: report of six cases.

Six cases of schistosomal cholecystitis are reported; five also had calculi. Histopathological studies revealed extensive fibrocalcific reaction of the walls and around the cystic ducts. We hypothesise that this fibrosis produced strictures of the cystic duct and stagnation of bile, predisposing to cholelithiasis. Surgeons practising in endemic areas should be aware of this rare complication of chronic schistosomiasis.

Biliary tract disease due to Fasciola hepatica: report of a case.

We report a case of a 23 year old woman who presented with symptoms of biliary tract disease to our University Hospital in Bayamón, Puerto Rico. A diagnosis of chronic cholelithiasis was made and the patient was taken to surgery. An adult Fasciola hepatica was recovered from the common bile duct. We review the pathobiology of this uncommon zoonosis.

Biliary tract disease due to fasciola hepatica: report of a case

We report a case of a 23 year old woman who presented with symptoms of biliary tract disease to our University Hospital in Bayamón, Puerto Rico. A diagnosis of chronic cholelithiasis was made and the patient was taken at surgery. An adult Fasciola hepática was recovered from the common bile duct. We review the pathobiology of this uncommon zoonosis

[Opisthorchiasis-induced strictures of the cystic duct]. / Opistorkhoznye striktury puzyrnogo protoka.

114 autopsy cases found during 3 years in Tomsk are analysed. A relationship between the strictures of the gallbladder duct and the duration and intensity of the opisthorchiasis invasion is established. The opisthorchiasis hinders the evacuation of the bile facilitates the development of the acute and chronic infection and cholelithiasis.

Biliary lithiasis and helminthiasis.

The syndrome of Oriental cholangiohepatitis is characterized by helminthiasis, choledocholithiasis often without cholecystolithiasis, biliary duct stricture and hepatic abscess. The common duct stones are usually multiple, black and friable. Fourteen cases have been seen in recent immigrants to the United States. Thirteen patients had choledocholithiasis, and 1 had viable flukes in the ducts. Choledochoenterostomy is usually required because of multiple stones, including intrahepatic stones, or proven or presumed infestation with Clonorchis sinensis. The latter, the Chinese liver fluke, is an infestation for which medical therapy does not exist. Resection, particularly of the lateral segment of the left hepatic lobe, may be required in cases of abscess and stones associated with stricture of the left hepatic duct.

[Choledochal obstruction due to Fasciola hepatica (author's transl)]. / Obstrucción del colédoco por Fasciola hepatica.

A 45-year-old woman was admitted in July, 1976 with an acute cholecystitis without jaundice. She had suffered from hepatic colic without fever, jaundice, diarrhea or allergic episodes for the past 8 years. The physical examination only revealed an elective pain on the cystic point. Laboratory data were unremarkable, except for a 12 percent eosinophils. The cholecystogram showed a cholelithiasis. The lithiasis was confirmed during the surgical operation and a fasciolasis was diagnosed after one and 10-12 parasites had been found into the cystic and common bile duct, respectively. A cholecistectomy and choledochoduodenostomy were performed. The patient was treated with 60 mg dehydroemetine during 10 days and 500 mg chloroquine during the other next 10 days. Eggs of Fasciola hepatica were found in the stool culture. The follow-up examinations 3 months and a year after surgery were completely normal. The national literature on this topic is reviewed and the clinical manifestations and therapy of this disease are commented on.