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Gallstone disease represents one of the most common and costly gastroenterological disorders. In Germany, 0.25% of the population undergo cholecystectomy per year, and cholelithiasis incurs annual medical expenses of more than USD 6.5 billion in the United States. The paradigm of environmental risk factors for gallstones has lately been challenged...
Citations
... Gallstones are crystal deposits in the biliary system, including the gallbladder and bile duct. Gallstones commonly affect 10 -20% of the global adult population [1], and the resultant cost of gallbladder disease constitutes a major health burden [2]. With changes in dietary patterns and the aging population, the incidence of gallstones is increasing. ...
Background: The gut and biliary microbiota are important components of the complex microecology system in the human body. However, it is often difficult to obtain bile in clinical practice to manage gallstone diseases, warranting further microbiota research to evaluate the relationship between biliary microbiota and gallstone formation. Aims: We aimed to characterize the diversity and alterations of biliary and gut microbiota in patients with gallstones and analyze their possible correlations to gallstone formation. Methods: We collected gallstones, bile, gallbladder mucosa, and feces from 21 patients with gallstone disease during operation and fecal samples from 20 healthy subjects without gallstones. We performed high-throughput sequencing of the V3-V4 regions of the 16S rRNA gene in the gallstone and control groups and analyzed the final optimization sequence. Results: We identified a total of 23,427 operational taxonomic units. Achromobacter (P = 0.010), Faecalibacterium (P = 0.042), and Lachnospira (P = 0.011) were significantly reduced, while Enterococcus (P = 0.001) was increased in the gallstone group. The diversity and composition between the biliary and gut microbiota in gallstone patients had statistical differences. The diversity of gut microbiota was significantly higher than that of biliary microbiota (P < 0.05). In addition, linear discriminant analysis (LDA) >4 indicated that the characteristic flora was specific to five samples. Prevotella and Proteobacteria had LDA values >4 in the feces and both bile and gallbladder mucosa, respectively, of patients with gallstones. Conclusion: The biliary and gut microbiota of patients with gallstones displayed bacterial heterogeneity. Prevotella and Proteobacteria may serve as biomarkers for dysbacteriosis in patients with gallstones, suggesting that alterations of biliary and gut microbiota are involved in the formation of gallstones. This study highlights the potential application of fecal microbiota transplantation technology in the treatment of gallstone diseases. Relevance for Patients: Microecology of the digestive tract is closely related to the formation of gallstones, providing new ideas for the prevention and treatment of patients with gallstones.
... Cholelithiasis is one of the most common diseases of the digestive system [10]. Cholecystectomy is the standard treatment for symptomatic cholelithiasis. ...
Background
Cholelithiasis or cholecystectomy is associated with bile reflux and may potentially contribute to the development of gastroesophageal reflux disease (GERD), Barrett's esophagus (BE), and esophageal adenocarcinoma (EAC); however, current observational studies yield inconsistent findings.
Methods
A search of literature until 3 November 2023 was done in PubMed, Web of Science, and Embase. Meta-analysis of observational studies assessing correlations between cholelithiasis or cholecystectomy and GERD, BE, and EAC risk factors were conducted. Mendelian randomization (MR) was then employed to assess the causative impact of genetic pre-disposition for cholelithiasis or cholecystectomy on these esophageal diseases.
Results
The results of the Meta-analysis indicated that cholelithiasis was significantly linked to an elevated risk in the incidence of BE (OR, 1.77; 95% CI, 1.37–2.29; p < 0.001) and cholecystectomy was a risk factor of GERD (OR, 1.37; 95%CI, 1.09–1.72; p = 0.008). We observed significant genetic associations between cholelithiasis and both GERD (OR, 1.06; 95% CI, 1.02–1.10; p < 0.001) and BE (OR, 1.21; 95% CI, 1.11–1.32; p < 0.001), as well as a correlation between cholecystectomy and both GERD (OR, 1.04; 95% CI, 1.02–1.06; p < 0.001) and BE (OR, 1.13; 95% CI, 1.06–1.19; p < 0.001). After adjusting for common risk factors, such as smoking, alcohol consumption and BMI in multivariate analysis, these variables still increase the risk of GERD and BE.
Conclusions
Our findings suggest that patients with cholelithiasis, regardless of whether they have undergone cholecystectomy or not, should prioritize the prevention and management of esophageal disorders.
... Accordingly, the therapies commonly used for KC, kidney surgery and chemotherapeutics can themselves cause AKI and CKD, which further complicates the relationship between KC and KD [58 ]. In support of these observations, recent studies supported an increased risk of KC in patients with gallstones [59 ], which are likely to result from the interaction of a spectrum of environmental and genetic risk factors associated with chronic overnutrition with carbohydrates, depletion of dietary fiber, age, female sex, type 2 DM, obesity and low physical inactivity [60 ]. Of note, cholelithiasis shares risk factors with CKD and KD, strongly suggesting a common underlying mechanism. ...
Kidney cancer (KC) is a disease with a rising worldwide incidence estimated at 400 000 new cases annually, and a worldwide mortality rate approaching 175 000 deaths per year. Current projections suggest incidence continuing to increase over the next decade, emphasizing the urgency of addressing this significant global health trend. Despite the overall increases in incidence and mortality, striking social disparities are evident. Low- and middle-income countries bear a disproportionate burden of the disease, with higher mortality rates and later-stage diagnoses, underscoring the critical role of socioeconomic factors in disease prevalence and outcomes. The major risk factors for KC, including smoking, obesity, hypertension and occupational exposure to harmful substances, must be taken into account. Importantly, these risk factors also often contribute to kidney injury, a condition that the review identifies as a significant, yet under-recognized, precursor to KC. Finally, the indispensable role of nephrologists is underscored in managing this complex disease landscape. Nephrologists are at the forefront of detecting and managing kidney injuries, and their role in mitigating the risk of KC is becoming increasingly apparent. Through this comprehensive analysis, we aim to facilitate a more nuanced understanding of KC's epidemiology and determinants providing valuable insights for researchers, clinicians and policymakers alike.
... Approximately 80% of gallstone patients remain asymptomatic; however, without timely intervention, the clinical course of gallstones can progress from asymptomatic carriers to symptomatic and complex conditions such as acute cholecystitis, cholangitis, pancreatitis, and, in rare instances, intestinal obstruction (5,6). Numerous studies have demonstrated that disorders of cholesterol metabolism, unhealthy lifestyle habits, genetic factors, obesity, and pregnancy significantly contribute to the development of gallstone disease (1,(7)(8)(9). ...
Background
With the use of cobalt alloys in medical prosthetics, the risk of cobalt exposure has increased. The objective of this study was to investigate the correlation between blood cobalt levels and the occurrence of gallstones utilizing data from the National Health and Nutrition Examination Survey (NHANES).
Methods
Data collected between 2017 and 2020 were analyzed, encompassing a total of 5,610 participants. Cobalt concentrations in whole blood specimens were directly measured using inductively coupled plasma mass spectrometry (ICP-MS). The presence of gallstones was ascertained through a standardized questionnaire. To assess the association between blood cobalt levels and the presence of gallstones, logistic regression analysis, restricted cubic spline analysis, and subgroup analysis were utilized.
Results
The results of logistic regression analysis revealed a heightened risk of developing gallstones in the Quartiles 2 and Quartiles 4 groups based on blood cobalt levels when compared to the Quartiles 1 group (OR = 1.54, 95% CI: 1.15–2.07; OR = 1.35, 95% CI: 1.03–1.77). The restricted cubic spline analysis exhibited a positive linear correlation between blood cobalt levels and the occurrence of gallstones. Subgroup analyses further demonstrated a statistically significant correlation between the Quartiles 4 category of blood cobalt levels and an elevated risk of gallstones, particularly among individuals aged 60 years or older, females, those with a body mass index (BMI) equal to or exceeding 25, serum total cholesterol levels below 200 mg/dL, as well as individuals diagnosed with hypertension or diabetes.
Conclusion
Our study findings indicate a notable association between elevated blood cobalt levels and an increased risk of gallstones. To establish a causal relationship between blood cobalt levels and the elevated risk of developing gallstones, further prospective cohort studies are warranted.
... These nutritional factors have been associated with the potential of producing lithogenic bile. Overweight and obesity are both lithogenic because they increase the cholesterol synthesis and its secretion, which together with a low-fi ber intake that is associated with intestinal hypomotility, produced a signifi cantly increased risk of developing a GD [6]. Regarding high-calorie intake, studies about the risk of developing GD are not conclusive, although generally results tend to associate higher calorie intakes with a greater risk. ...
... Although the hypothesis suggesting high-high-calorie diets are correlated with low-density nutritional foods, carbohydrates and refi ned fats intake, lowfi ber intake, and low vitamin and minerals intake, this is not a risk factor that has been proved in many studies. This causes an increase in overweight and obesity, as well as metabolic syndrome, pathologies that have proved to be lithogenics due to increased cholesterol synthesis and its secretion, increasing the risk of developing a GD [6]. ...
The etiology of Gallstone Disease (GD) is multivariate and it involves genetics and environmental factors. Nutritional exposure is considered the main environmental influence that contributes to gallstone formation. The aim of this study was to assess the association between diet and GD. A nested case-control study based on a previous representative screening of asymptomatic subjects living in Rosario, Argentina, was carried out. Participants underwent a personal interview. Food and nutrient intake were estimated by applying a food-frequency questionnaire, a food photography atlas, and software for food composition. Logistic regression analysis was used to estimate Odds Ratios (OR) and 95% confidence intervals, adjusted by potential confounders. A total of 120 patients, 51 cases and 69 controls, were studied. Statistically significant differences in average daily energy intake were found between cases and controls (p = 0.002). Total fats, chicken with skin, sausages, and cold cuts intakes were higher in the cases group. However, the control group was characterized by a statistically significant higher consumption of vegetables, fresh fruits, nuts, chicken without skin, and skimmed dairy products. Multiple logistic regression showed that GD risk diminished with red and yellow vegetables (OR = 0.037; p = 0,0004) and nuts consumption (OR = 0.201; p = 0.019). Instead, GD risk increases with total fats (OR = 7.959; ρ = 0.0205), fatty cattle meat (OR = 18.163; p = 0.0063), and chicken with skin consumption (OR: 10.595; p = 0.0050). Phosphorus consumption decreases GD risk (OR = 0.055; p = 0.0035). A number of meals also acted as a protective factor. Also, caloric intake was a risk factor. Each 100 kilocalories daily consumed; the risk increases by 12%.
... Early Recovery After Surgery (ERAS) protocols significantly reduce postoperative complications, pain, and time to discharge while speeding up functional recovery and leading to overall reduced hospital costs [3][4][5]. No generally accepted ERAS guidelines exist for elective ambulatory cholecystectomy, despite over 900,000 cholecystectomies being undertaken annually in the United States alone [6]. Since 2007, our institution has refined our own protocol to decrease postoperative pain, morbidity, and time to discharge while improving patient satisfaction, cosmesis, and functional recovery after cholecystectomy. ...
Introduction
This study compares outcomes after LESS cholecystectomy utilizing epidural versus general anesthesia.
Methods
Patients undergoing LESS Cholecystectomy were randomized into receiving epidural or general anesthesia by protocol. Patients used a Visual Analog Scale to rate pain from 0 (no pain) to 10 (severe pain). Data presented as median (mean ± standard deviation).
Results
75 patients underwent LESS cholecystectomy with general anesthesia [32 patients (22% men) after five patients withdrew consent] or epidural anesthesia [23 patients (22% men) after 15 patients withdrew consent]. Respectively, they were of age 38 years (41 ± 15.1) and 47 years (48 ± 13.9), BMI 29 (28 ± 4.9) kg/m² and 28 (28 ± 3.8) kg/m², and ASA 2 (2 ± 0.5) and 2 (2 ± 0.3) (p > 0.05 for all). LOS for patients receiving general vs. epidural anesthesia was 72 min (122 ± 104.4) vs. 95 min (113 ± 77.5) (p = 0.25). On POD 0, patients receiving general anesthesia rated pain as 4 (4 ± 2.9) vs. 0 (1 ± 2.2) for epidural anesthesia (p = 0.02). On POD 1, they rated pain as 6 (5 ± 2.3) vs. 6 (6 ± 2.9) (p = 0.68). On POD 6, patients rated pain as 3 (3 ± 2.7) vs. 4 (3 ± 2.2) (p = 1.00). For patient satisfaction with incisional scars for those receiving general vs. epidural anesthesia, patients rated their scars to be 10 (8 ± 3.6) vs. 10 (9 ± 1.2) (p = 0.21). Total costs for the hospital using general vs. epidural anesthesia were found $6,909 (7,167 ± 2,083.8) vs. $6,225 (5,848 ± 1530.1) (p = 0.014), respectively. Patients self-assessed satisfaction on a scale of 1 (worst) to 5 (best) as a 5 (5 ± 0).
Conclusions
Patients undergoing LESS cholecystectomy with general vs. epidural anesthesia had similar demographics, LOS, and pain scores. Patients that received epidural anesthesia reported less pain and incurred less cost. Utilization of epidural anesthesia in lieu of general anesthesia for LESS cholecystectomy is safe, reduces pain, and offers potential cost savings.
... Moreover, the prevalence of this chronic disease increases with age, thus, it has been drawn more attention in this aging social condition. Several risk factors have been identi ed to contribute to lithogenic development, mainly consisting of genetic liability and exogeneous factors: metabolism-disturbed factors, abnormal dietary behaviors, gallbladder hypomotility and certain drugs [23]. Moreover, though ursodeoxycholic acid (UDCA) is substantially su cient during the gallstone disorder progression, pharmacological prevention of gallstones is not advisable, instead lifestyle is robustly prioritized to maintain ideal body weight [24]. ...
Background: Gallstone diseases and cholecystectomy are possibly associated with the severity of COVID-19 bidirectionally, yet the casual association remains unclear.
Method: Applying genome-wide association study summary statistics of primarily European individuals, we utilized 2-sample Mendelian randomization to estimate the bidirectional causal effects of cholelithiasis, cholecystitis and cholecystectomy on three COVID-19 phenotypes: SARS-CoV-2 infection, COVID-19 hospitalization and severe COVID-19.
Results: Inverse variance weighted Mendelian randomization results from the FinnGen consortium showed that none of cholelithiasis, cholecystitis and cholecystectomy was not causally associated with COVID-19 phenotypes, and vice versa. In addition, other methods including MR-Egger, weighted median, weight mode and simple mode exhibited approximate tendency as IVW. These results were all robust to sensitivity analysis.
Conclusion: The forward MR analysis showed no causally significant impact of cholelithiasis, cholecystitis and cholecystectomy on COVID-19 phenotypes. Similarly, reverse MR results also showed no causal association between COVID-19 and cholelithiasis events.
... The combination of estrogen and progesterone creates a high cholesterol-bile sludge environment in the gallbladder, which is most suitable for stone formation [31]. In addition, oral administration of some drugs containing estrogen, progesterone and the growth inhibitor analogue octreotide are likely to cause gallstones [32], the cause may be progesterone and octreotide causing hypokinesis of the gallbladder [33], delays the emptying of bile, further promoting the formation of gallstones. ...
... Several limitations exist in this study. Firstly, the crosssectional design precluded causal inference, and our findings need prospective cohort validation [32]. Secondly, self-reported milk intake is subject to recall bias. ...
Background:
Cholelithiasis is a common digestive system disease that imposes major burden on patients and society. Investigating the relationship between dietary factors and cholelithiasis risk can provide a basis for disease prevention. Previous studies on milk intake and cholelithiasis incidence have been limited.Therefore, the aim of our study was to assess the association between milk consumption and the incidence of cholelithiasis in males and females.
Methods:
We selected 14,722 adults (≥ 18 years old) from National Center for Health Statistics (NHANSE) 2017-2020, and collected general characteristics of patients in the database, such as age, gender, race and body mass index (BMI), as well as dietary information (milk consumption). The occurrence of cholelithiasis was used as the outcome event, and the group was divided into cholelithiasis and non-cholelithiasis groups according to the outcome event. We used logistic regression models in generalized linear model (GLM) functions, controlling for demographic, lifestyle, and dietary factors, to estimate the association between milk intake and the incidence of cholelithiasis in males and females.
Results:
A total of 14,722 adults were included. In the present study, the overall weighted prevalence of cholelithiasis was 10.96%, with 15.18% and 6.48% prevalence in females and males, respectively. Compared to infrequent milk intake, frequent milk intake (once a week or more) in females was associated with reduced cholelithiasis risk (OR 0.74, 95% CI 0.61-0.90). Daily milk intake in males was also related to lower cholelithiasis risk (OR 0.69-0.82). As adjusted variables increased in the models, predictive performance was improved (AUC 0.711 in females, 0.730 in males).
Conclusions:
Appropriate milk intake may correlate with decreased cholelithiasis risk. Our study provides a basis for dietary interventions against gallstones, but prospective studies are needed to verify the results.
... A Swedish study done on twins in 43,141 patients showed that 25% of risk of GSD is determined by the underlying genetic predisposition [5]. These studies confirmed specific gene polymorphism in the formation of gallstones but the environmental factors including diet and physical activity have also the crucial role [6][7][8][9][10][11]. ...
Gallstone disease (GSD) refers to all patients with symptoms due to gallstones (cholelithiasis). The presence of gallstones is a common problem seen in 10-15% of the Western population; with 1-4% developing symptoms. The most common presentation of patients with GSD is biliary colic. There are several mechanisms for cholelithiasis and all these processes are slow. Cholesterol stones are the most common variety of gallstones. Cholesterol stones cannot form if the gallbladder is completely emptied several times a day. Therefore, the total or partial extension of bile storage due to impaired gallbladder movement seems to be an important factor for cholelithiasis. Gallbladder dysmotility is an important risk factor for the development of GSD. Insufficient gallbladder motility may be associated with many risk factors for cholesterol gallstone formation, such as pregnant women, obese patients, and rapid weight loss, diabetes mellitus, and patients receiving total parenteral nutrition. Transabdominal ultrasound is the mainstay in the evaluation of patients with GSD. The presence of gallbladder dysfunction can be studied using cholecystokinin (CCK)-stimulated cholescintigraphy to evaluate for gallbladder ejection fraction (GBEF); with values <40% after 30 mins of CCK infusion considered diagnostic. The definitive treatment of GSD is cholecystectomy.
... The combination of estrogen and progesterone creates a high cholesterol-bile sludge environment in the gallbladder, which is most suitable for stone formation(28). In addition, oral administration of some drugs containing estrogen, progesterone and the growth inhibitor analogue octreotide are likely to cause gallstones (29), the cause may be progesterone and octreotide causing hypokinesis of the gallbladder (30), delays the emptying of bile, further promoting the formation of gallstones. In addition, previous studies have shown that goat milk supplementation does not increase the lithogenic index or increase liver oxidative damage compared to cow's milk intake (23). ...
Background: Previous studies support the association of dietary factors with the development of cholelithiasis, but the relationship between milk consumption and the incidence of cholelithiasis has not been reliably studied. Therefore, the aim of our study was to assess the association between milk consumption and the incidence of cholelithiasis in male and female.
Method: We selected 14722 adults (≥18 years old) from National Center for Health Statistics (NHANSE) 2017-2020, and collected general characteristics of patients in the database, such as age, gender, race and body mass index (BMI), as well as dietary information (milk consumption). The occurrence of cholelithiasis was used as the outcome event, and the group was divided into cholelithiasis and non-cholelithiasis groups according to the outcome event. We used logistic regression models in generalized linear model (GLM) functions, controlling for demographic, lifestyle, and dietary factors, to estimate the association between milk intake and the incidence of cholelithiasis in male and female.
Result: In the present study, the overall weighted prevalence of cholelithiasis was 10.96%, with 15.18% and 6.48% prevalence in women and men, respectively. After multivariate adjustment, regular milk intake was associated with a lower incidence of cholelithiasis in female（OR：0.75，95% CI：0.60-0.94, P=0.012）.
Conclusion: To our knowledge, this is the first prospective study to investigate the association between milk intake and the incidence of gallstone disease; the study suggests that regular milk intake may help reduce the risk of gallstone incidence in both male and female.
