Dynamic changes in the gallbladder wall, in the gallbladder bile and in the liver in patients with symptomatic (with biliary pain) biliary diseases

Share this:  

Read this article in pdf format

Early detection and the treatment of symptomatic (with biliary pain) biliary diseases have the important clinical importance because of transformation of functional disturbances biliary system into the organic pathology - gallbladder dysfunction → chronic acalculous cholecystitis without biliary sludge → chronic acalculous cholecystitis with biliary sludge → chronic calculous cholecystitis (table 4).

It is a result of disturbance of colloidal stability of the gallbladder bile, of precipitation of the cholesterol monohydrate crystals and calcium bilirubinate granules, and the addition of chronic aseptic inflammation in the gallbladder wall (table 5).

Laparoscopic cholecystectomy is a “gold” standard of the treatment of chronic calculous cholecystitis.

The absence of gallbladder promotes the appearance of the functional biliary hypertension and the dilation of the common hepatic duct and common bile duct. In some patients it is accompanied with progressive deterioration of the chronic pancreatitis, with appearance of dysfunction of Oddi's sphincter, of duodeno-gastral reflux and/or of reactive hepatitis (table 6).

Possibly, the symptomatic (with biliary pain) biliary diseases are the “COX-2” associated biliary diseases. The main cause of these diseases is the excessive COX-2 expression in the smooth muscle cells and in the epithelial cells of the gallbladder and of the common hepatic duct and common bile duct.

Probably, the symptomatic (with biliary pain) biliary diseases are the diseases of the smooth muscle cells of the gallbladder wall or of the smooth muscle cells of cystic duct, of the common bile duct sphincter or of the pancreatic duct sphincter or of the sphincter of ampulla (the excessive COX-2 expression).

References:

1. Mackay S, Dillane P. Biliary pain. Aust Fam Physician. 2004; 33(12): 977-981.
2. Lee S.P., Nicholls J.F. Nature and composition of biliary sludge. Gastroenterology. 1986; 90: 677-686.
3. Carey M.C., Cahalane M.J. Whither biliary sludge? Gastroenterology. 1988; 95: 508-523.
4. Wilkinson L.S., Levine T.S., Smith D., Chadwick S.J. Biliary sludge: can ultrasound reliably detect the presence of crystals in bile? Europ. J. Gastroenterol. Hepatol. 1996; 8: 999-1001.
5. Inoue K., Fuchigami A., Higashide S. et al. Gallbladder sludge and stone formation in relation to contractile function after gastrectomy. Ann. Surg. 1992; 215: 19-26.
6. Jungst D., del Pozo R., Christoph S. et al. Quantification of biliary sludge in patients with cholesterol, mixed and pigment stones. Gastroenterology. 1994; 106(4): Abstr. 912.
7. Jungst D., del Pozo R., Christoph S. et al. Sedimentation of biliary sludge. Effect on composition of gallbladder bile from patients with cholesterol, mixed and pigment stones. Scand. J. Gastroenterol. 1996; 31: 273-278.
8. Jüngst C, Sreejayan N, Zündt B, Müller I, Spelsberg FW, Hüttl TP, Kullak-Ublick GA, del Pozo R, Jüngst D, von Ritter C. Ursodeoxycholic acid reduces lipid peroxidation and mucin secretagogue activity in gallbladder bile of patients with cholesterol gallstones. Eur J Clin Invest. 2008; 38(9): 634-639.
9. Jüngst C, Sreejayan N, Eder MI, von Stillfried N, Zündt B, Spelsberg FW, Kullak-Ublick GA, Jüngst D, von Ritter C. Lipid peroxidation and mucin secretagogue activity in bile of gallstone patients. Eur J Clin Invest. 2007; 37(9): 731-736.
10. Fischer S, Müller I, Zündt BZ, Jüngst C, Meyer G, Jüngst D. Ursodeoxycholic acid decreases viscosity and sedimentable fractions of gallbladder bile in patients with cholesterol gallstones. Eur J Gastroenterol Hepatol. 2004; 16(3): 305-311.
11. Sauter GH, Thiessen K, Parhofer KG, Jüngst C, Fischer S, Jüngst D. Effects of ursodeoxycholic acid on synthesis of cholesterol and bile acids in healthy subjects. Digestion. 2004; 70(2): 79-83.
12. Bueno Lledó J, Planells Roig M, Arnau Bertomeu C, Sanahuja Santafé A, Oviedo Bravo M, García Espinosa R, et al. Outpatient laparoscopic cholecystectomy: a new gold standard for cholecystectomy. Rev Esp Enferm Dig 2006; 98: 14-24.
13. Barthet M., Affriat C., Bernard J.P. et al. Is biliary lithiasis associated with pancreatographic changes? Gut. 1995; 36(5): 761-765.
14. Barthet M., Spinoza S., Affriat C. et al. Influence of age and biliary lithiasis on the diameter of the common bile duct. Gastroenterol. clin. Biol. 1995; 19: 156-160.
15. Potter G.D. Bile acid diarrhea. Dig. Dis. Sci. 1998; 16: 118-124.
16. Popovic O., Mivolic V., Kostic K. et al. Bile acid-media­ted postcho­lecyst­ec­to­my diar­rhea. Gastroenterol. Inter. 1988; 1: Abstr. 790.
17. Portincasa P., van de Meeberg P., van Erpecum K.J. et al. An update on the pathogenesis and treatment of cholesterol gallstones. Scand. J. Gastroenterol. 1997; 223: 60-69.
18. Portincasa P., di Ciaula A., Palmieri V. et al. Impaired gallbladder and gastric motility and pathological gastroesophagal reflux in gallstone patients. Europ. J. clin. Invest. 1997; 27:  653-661.
19. Fort J.M., Azpiroz F., Casellas F. et al. Bowel habit after cholecystectomy: physiological changes and clinical implications. Gastroenterology. 1996; 111: 617-622.
20. Isogai M., Yamaguchi A., Hori A., Nakano S. Hepatic histopathological changes in biliary pancreatitis. Amer. J. Gastroenterol. 1995; 90(3): 449-454.
21. Honda A., Yoshida T., Tanaka N., Matsuzaki Y., He B., Shoda J., Osuga T. Increased bile acid concentration in liver tissue with cholesterol gallstone disease. J Gastroenterol 1995; 30(1): 61-66.
22. Geraghty J.M., Goldin R.D. Liver changes associated with cho­lecystitis. J Clin Pathol 1994; 47(5): 457-460.
23. Guarino MP, Carotti S, Sarzano M, Alloni R, Vanni M, Grosso M, Sironi G, Maffettone PL, Cicala M. Short-term ursodeoxycholic acid treatment improves gallbladder bile turnover in gallstone patients: a randomized trial. Neurogastroenterol Motil. 2005; 17(5): 680-686.
24. Pazzi P, Petroni ML, Prandini N, Adam JA, Gullini S, Northfield TC, Jazrawi RP. Postprandial refilling and turnover: specific gallbladder motor function defects in patients with gallstone recurrence. Eur J Gastroenterol Hepatol. 2000; 12(7): 787-794.
25. Jazrawi RP, Pazzi P, Petroni ML, Prandini N, Paul C, Adam JA, Gullini S, Northfield TC. Postprandial gallbladder motor function: refilling and turnover of bile in health and in cholelithiasis. Gastroenterology. 1995; 109(2): 582-591.
26. Chen XW, Cai JT. The impact of selective cycloxygenase-2 inhibitor celexibo on the formation of cholesterol gallstone. Zhonghua Nei Ke Za Zhi. 2003; 42(11): 797-799.
27. Shoda J, Ueda T, Kawamoto T, Todoroki T, Asano T, Sugimoto Y, Ichikawa A, Maruyama T, Nimura Y, Tanaka N. Prostaglandin E receptors in bile ducts of hepatolithiasis patients and the pathobiological significance for cholangitis. Clin Gastroenterol Hepatol. 2003; 1(4): 285-96.
28. Kano M, Shoda J, Satoh S, Kobayashi M, Matsuzaki Y, Abei M, Tanaka N. Increased expression of gallbladder cholecystokinin: a receptor in prairie dogs fed a high-cholesterol diet and its dissociation with decreased contractility in response to cholecystokinin. J Lab Clin Med. 2002; 139(5):85-94.
29. Shoda J, Kano M, Asano T, Irimura T, Ueda T, Iwasaki R, Furukawa M, Kamiya J, Nimura Y, Todoroki T, Matsuzaki Y, Tanaka N. Secretory low-molecular-weight phospholipases A2 and their specific receptor in bile ducts of patients with intrahepatic calculi: factors of chronic proliferative cholangitis. Hepatology. 1999; 29(4): 1026-1036.
30. Kano M, Shoda J, Irimura T, Ueda T, Iwasaki R, Urasaki T, Kawauchi Y, Asano T, Matsuzaki Y, Tanaka N. Effects of long-term ursodeoxycholate administration on expression levels of secretory low-molecular-weight phospholipases A2 and mucin genes in gallbladders and biliary composition in patients with multiple cholesterol stones. Hepatology. 1998; 28(2): 302-313.
31. Shoda J, Ueda T, Ikegami T, Matsuzaki Y, Satoh S, Kano M, Matsuura K, Tanaka N. Increased biliary group II phospholipase A2 and altered gallbladder bile in patients with multiple cholesterol stones. Gastroenterology. 1997; 112(6): 2036-2047.
32. Sasaki H, Tazuma S, Kajiyama G. Effects of 16,16-dimethyl prostaglandin E2 on biliary mucous glyco-protein and gallstone formation in guinea pigs. Scand J Gastroenterol. 1993; 28(6): 495-499.
33. Minetoma T. Relationship between gallbladder contractility and muscular fibrosis in the patients with cholecystolithiasis - immunohistochemical analysis. Nippon Shokakibyo Gakkai Zasshi. 1993; 90(12): 3018-3027.
34. Hidaka T, Nakano M, Inokuchi T, Sugiyama M, Nishi J, Ogura R. Arachidonate metabolism in bovine gallbladder mucosa. Kurume Med J. 1991; 38(3): 129-133.
35. Nilsson B, Delbro D, Hedin L, Friman S, Andius S, Svanvik J. Role of cyclooxygenase-2 for fluid secretion by the inflamed gallbladder mucosa. J Gastrointest Surg. 1998; 2(3): 269-277.
36. Chapman WC, Peterkin GA, LaMorte WW, Williams LF Jr. Alterations in biliary motility correlate with increased gallbladder prostaglandin synthesis in early cholelithiasis in prairie dog. Dig Dis Sci. 1989; 34(9): 1420-1424.
37. Svanvik J, Thornell E, Zettergren L. Gallbladder function in experimental cholecystitis. Surgery. 1981; 89(4): 500-506.
38. Guarino MP, Cong P, Cicala M, Alloni R, Carotti S, Behar J. Ursodeoxycholic acid improves muscle con-tractility and inflammation in symptomatic gallbladders with cholesterol gallstones. Gut. 2007; 56(6): 815-820.
39. Colecchia A, Mazzella G, Sandri L, Azzaroli F, Magliuolo M, Simoni P, Bacchi-Reggiani ML, Roda E, Festi D. Ursodeoxycholic acid improves gastrointestinal motility defects in gallstone patients. World J Gastroenterol. 2006; 12(33): 5336-5343.
40. Xiao ZL, Biancani P, Carey MC, Behar J. Hydrophilic but not hydrophobic bile acids prevent gallbladder muscle dysfunction in acute cholecystitis. Hepatology. 2003; 37(6): 1442-1450.
41. MacPherson B.R., Pemsingh R.S. Ground squirrel model for cholelithiasis: role of epithelial glycoproteins. Microsc Res Tech. 1997; 39(1): 39-55.
42. Pemsingh R.S., Macpherson B.R., Scott G.W. Characterization of lipid accumulation in the gallbladder mucosa of the Ground Squirrels fed a lithogenic diet. J Pathology. 1988; 154(2): 173-180.
43. Pemsingh R.S., Macpherson B.R., Scott G.W. Mucus hypersecretion in the gallbladder epithelium of Ground Squirrels fed a lithogenic diet for the induction of cholesterol gallstones. Hepatology. 1987; 7(6): 1267-1271.
44. Pemsingh R.S., Macpherson B.R., Scott G.W. Morphological observations on the gallbladder of Ground Squirrels fed a lithogenic diet. J Pathology. 1987; 152: 127-135.
45. Macpherson B.R., Pemsingh R.S., Scott G.W. Experimental cholelithiasis in the Ground Squirrel. Laboratory Investigation. 1987; 56(2): 138-145.
46. Meyers D, Feldstein DA. Initial treatment of biliary colic: are NSAIDs better than opiates? WMJ. 2005; 104(4): 9.
47. Myers SI, Bartula LL, Colvin MP, Parkman HP. Cholecystokinin (CCK) down regulates PGE2 and PGI2 release in inflamed Guinea pig gallbladder smooth muscle cell cultures. Prostaglandins Leukot Essent Fatty Acids. 2005; 73(2): 121-126.
48. Myers SI, Riva A, Kalley-Taylor B, Bartula L. Taurodeoxycholic acid stimulates rabbit gallbladder eicosanoid release. Prostaglandins Leukot Essent Fatty Acids. 1995; 52(1): 35-39.
49. Myers SI, Inman LR, Kalley-Taylor B, Riva A, Bartula L. Increased intragallbladder pressure stimulates gallbladder eicosanoid release. Prostaglandins. 1994; 48(1): 53-66.
50. Myers SI, Bartula L. Human cholecystitis is associated with increased gallbladder prostaglandin I2 and prostaglandin E2 synthesis. Hepatology. 1992; 16(5): 1176-1179.
51. Myers SI, Bartula LL. Sex differences in gallbladder prostaglandin synthesis mediated by acute inflammation. Prostaglandins Leukot Essent Fatty Acids. 1990; 41(4): 259-264.
52. Kaminski DL. Arachidonic acid metabolites in hepatobiliary physiology and disease. Gastroenterology. 1989; 97(3): 781-792.
53. Kaminski DL, Deshpande Y, Thomas L, Qualy J, Blank W. Effect of oral ibuprofen on formation of prostaglandins E and F by human gallbladder muscle and mucosa. Dig Dis Sci. 1985, 30 (10): 933-940.
54. Xiao ZL, Amaral J, Biancani P, Behar J. Impaired cytoprotective function of muscle in human gallbladders with cholesterol stones. Am J Physiol Gastrointest Liver Physiol. 2005; 288(3): G525-G532.
55. Prystowsky JB, Rege RV. The inflammatory effects of crystalline cholesterol monohydrate in the guinea pig gallbladder in vivo. Surgery. 1998; 123(3): 258-263.
56. Kumar A, Deed JS, Bhasin B, Kumar A, Thomas S. Comparison of the effect of diclofenac with hyoscine-N-butylbromide in the symptomatic treatment of acute biliary colic. ANZ J Surg. 2004; 74(7): 573-576.
57. Akriviadis EA, Hatzigavriel M, Kapnias D, Kirimlidis J, Markantas A, Garyfallos A. Treatment of biliary colic with diclofenac: a randomized, double-blind, placebo-controlled study. Gastroenterology. 1997; 113(1): 225-231.
58. Anez MS, Martínez D, Pacheco JL, Gonzalez H, Rivera J, Pelaschier E, Uzcategui L, Romero MD, Molina Z, Roditti de Montilla M, et al. Indomethacin in the treatment of acute cholecystitis and biliary colic. G E N. 1991; 45(1): 32-37.
59. Goldman G, Kahn PJ, Alon R, Wiznitzer T. Biliary colic treatment and acute cholecystitis prevention by prostaglandin inhibitor. Dig Dis Sci. 1989; 34(6): 809-811.
60. Torsoli A, Corazziari E, Habib FI, Cicala M. Pressure relationships within the human bile tract. Normal and abnormal physiology. Scand J Gastroenterol Suppl 1990; 175: 52-57.
61. Krishnamurthy S, Krishnamurthy GT. Biliary dyskinesia: role of the sphincter of Oddi, gallbladder and cholecystokinin. J Nucl Med. 1997; 38: 1824-1830.