Cholangitis ; diagnosis ; etiology ; therapy ; Humans ; Immunoglobulin G ; metabolism

Fibrinolytic properties have been detected in animal and human gallbladder (GB) bile. Plasminogen activator inhibitor-1 (PAI-1) has been reported in greater concentration in GB stone bile and may be a nucleating factor in the pathogenesis of GB stone formation. It is unknown whether or not human choledochal bile has similar properties, which could have a role in choledocholithiasis. The aims of this study were to determine the presence of fibrinolytic properties of human choledochal bile and to compare those properties among normal, acalculous, and calculous-infected choledochal bile. Tissue plasminogen activator (t-PA) and PAI-1 of choledochal bile were measured by enzyme linked immunosorbent assay in patients with cholangitis due to acalculous bile duct obstructions (n = 9), choledocholithiasis with cholangitis (n = 20), and normal bile (n = 7). The t-PA concentration of choledochal bile was no different among the three groups (acalculous-infected bile, median 4.61 ng/ml, and calculous-infected bile, 4.61 ng/ml, versus normal bile, 7.33 ng/ml). PAI-1 was detected in choledochal bile in significantly greater concentrations in patients with acalculous cholangitis due to bile duct obstructions and choledocholithiasis with cholangitis (acalculous-infected bile, median 0.36 ng/ml, and calculous-infected bile, 0.1 ng/ml, versus normal bile, 0.02 ng/ml, p < 0.05), but the bile concentration of PAI-1 was no different between the acalculous and calculous-infected choledochal bile. Human choledochal bile possesses t-PA and PAI-1. PAI-1 was present in greater concentrations in both acalculous and calculous-infected choledochal bile. Increased levels of PAI-1 may be an epiphenomenon of cholangitis rather than a factor in the pathogenesis of choledocholithiasis.
Aged ; Bile/microbiology ; Bile/chemistry* ; Cholangitis/microbiology ; Cholangitis/metabolism ; Cholangitis/etiology ; Cholangitis/chemically induced ; Cholestasis/metabolism ; Cholestasis/complications ; Common Bile Duct/metabolism* ; Common Bile Duct Calculi/metabolism ; Common Bile Duct Calculi/complications ; Female ; Human ; Male ; Middle Age ; Plasminogen Activator Inhibitor 1/analysis* ; Tissue Plasminogen Activator/analysis*

Antigens, CD1 ; metabolism ; Child, Preschool ; Cholangitis, Sclerosing ; diagnosis ; etiology ; metabolism ; Diagnosis, Differential ; Female ; Histiocytosis, Langerhans-Cell ; complications ; metabolism ; pathology ; Humans ; Immunohistochemistry ; Liver ; metabolism ; pathology ; S100 Proteins ; metabolism

OBJECTIVETo observe the curative effects of biliary drainage via endoscope (ENBD) combined with Chinese drug medication on acute biliary tract infection (ABTI) and the influence of treatment on complement 3 (C3), C-reactive protein (CRP) and interleukin-6 (IL-6).

METHODSSixteen patients with ABTI were randomly assigned to two groups: the 9 patients in the combined treatment group (CTG) treated with ENBD combined with Chinese medicine and the 7 patients in routine treatment group (RTG) treated with ENBD alone. Another 18 patients with simple gallbladder stone were taken as the control group (CG). The curative effect was observed and the serum concentrations of C3, CRP and IL-6 were determined before and after treatment.

RESULTSBefore treatment, the concentrations of CRP and IL-6 were significantly higher and C3 lower in all ABTI patients than those in patients with simple gallbladder stone (P < 0.05 or P < 0.01). After treatment, the general condition of patients was improved, the recovery time of intestinal tract function was shortened and the concentrations of C3, CRP and IL-6 significantly decreased in CTG, with the effects better than those in RTG respectively (P < 0.01 or P < 0.05).

CONCLUSIONENBD combined with Chinese drug medication shows favorable curative effects on ABTI. Treatment with Chinese medicine according to syndrome differentiation could decrease blood level of pro-inflammatory cytokines and promote recovery of the injured immune function.

Adult ; Aged ; C-Reactive Protein ; metabolism ; Cholangitis ; blood ; therapy ; Combined Modality Therapy ; Complement C3 ; metabolism ; Drainage ; instrumentation ; methods ; Drugs, Chinese Herbal ; therapeutic use ; Endoscopy, Digestive System ; Female ; Humans ; Interleukin-6 ; blood ; Male ; Middle Aged ; Phytotherapy ; Treatment Outcome

Recent studies have proposed nomenclatures of type 1 autoimmune pancreatitis (AIP) (IgG4-related pancreatitis), IgG4-related sclerosing cholangitis (IgG4-SC), IgG4-related cholecystitis, and IgG4-related hepatopathy as IgG4-related disease (IgG4-RD) in the hepato-bilio-pancreatic system. In IgG4-related hepatopathy, a novel concept of IgG4-related autoimmune hepatitis (AIH) with the same histopathological features as AIH has been proposed. Among organs involved in IgG4-RD, associations with pancreatic and biliary lesions are most frequently observed, supporting the novel concept of "biliary diseases with pancreatic counterparts." Targets of type 1 AIP and IgG4-SC may be periductal glands around the bile and pancreatic ducts. Based on genetic backgrounds, innate and acquired immunity, Th2-dominant immune status, regulatory T (Treg) or B cells, and complement activation via a classical pathway may be involved in the development of IgG4-RD. Although the role of IgG4 remains unclear in IgG4-RD, IgG4-production is upregulated by interleukin 10 from Treg cells and by B cell activating factor from monocytes/basophils with stimulation of toll-like receptors/nucleotide-binding oligomerization domain-like receptors. Based on these findings, we have proposed a hypothesis for the development of IgG4-RD in the hepato-bilio-pancreatic system. Further studies are necessary to clarify the pathogenic mechanism of IgG4-RD.
Adaptive Immunity ; Autoimmune Diseases/*immunology ; B-Cell Activating Factor/metabolism ; Cholangitis, Sclerosing/*immunology ; Cholecystitis/*immunology ; Humans ; Immunoglobulin G/*immunology ; Interleukin-10/metabolism ; Liver Diseases/*immunology ; Pancreatitis/*immunology ; T-Lymphocytes, Regulatory/immunology

Adult ; Aged ; Cholangitis ; complications ; Cholecystitis, Acute ; complications ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Interleukin-2 ; blood ; Interleukin-6 ; blood ; Male ; Middle Aged ; Phytotherapy ; Systemic Inflammatory Response Syndrome ; drug therapy ; etiology ; Tumor Necrosis Factor-alpha ; metabolism

OBJECTIVETo investigate the expression pattern of human triggering receptor expressed on myeloid cells 1 (TREM-1) mRNA in peripheral blood mononuclear cells and its clinical significance in acute obstructive suppurative cholangitis (AOSC).

METHODSPeripheral blood mononuclear cells were collected from 36 patients with AOSC and 40 healthy adults. TREM-1 mRNA was determined by semi-quantitative RT-PCR, and TREM-1 protein by immunocytochemistry. Enzyme-linked immunosorbent assay (TNF-alpha) was used to detect the level of tumor necrosis factor-alpha (TNF-alpha), and immunoturbidimetry employed to detect C reactive protein.

RESULTSThe expression of TREM-1 mRNA relative to beta-actin was 1.007-/+0.252 in patients with AOSC, significantly higher than that in the healthy adults (0.457-/+0.053, P<0.05). The two groups also showed significantly different TREM protein expression (P<0.01). The AOSC patients exhibited significantly higher levels of TNF-alpha and C reactive protein than the healthy adults (P<0.01).

CONCLUSIONThe expression of human TREM-1 in peripheral blood mononuclear cells is up-regulated obviously in early stage of AOSC, probably suggesting an important role of TREM-1 in the development of AOSC.

Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Biomarkers ; blood ; Case-Control Studies ; Cholangitis ; blood ; complications ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Leukocytes, Mononuclear ; metabolism ; Male ; Membrane Glycoproteins ; genetics ; metabolism ; Middle Aged ; RNA, Messenger ; genetics ; metabolism ; Receptors, Immunologic ; genetics ; metabolism ; Sepsis ; blood ; etiology ; Triggering Receptor Expressed on Myeloid Cells-1

BACKGROUND/AIMS: We evaluated changes of causative pathogen in acute cholangitis and their antimicrobial susceptibility over six years and differences between community-acquired and hospital-acquired acute cholangitis at our institution. METHODS: Medical records of 1,596 patients with acute cholangitis and biliary drainage between August 2006 and August 2012 were reviewed retrospectively. Cases were divided according to time: period 1 (August 2006-December 2008, n=645, 40.4%), period 2 (January 2009-August 2012, n=951, 59.6%). Cases were divided according to community-acquired cholangitis (n=1,397, 87.5%) and hospital-acquired cholangitis (n=199, 12.5%). Causative pathogens and antimicrobial susceptibility were investigated in each group. RESULTS: Causative pathogen was isolated from bile culture in 1,520 out of 1,596 cases (95.2%). The three most frequently isolated Gram-negative bacteria were extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (n=485, 30.4%), E. coli (n=237, 13.2%), and Citrobacter freundii (n=110, 6.9%). Between periods 1 and 2, prevalence of ESBL-producing E. coli and Klebsiella pneumoniae did not show significant change (36.7% vs. 32.1%, p=0.073; 6.6% vs. 6.2%, p=0.732). C. freundii showed a significant increase from period 1 to period 2 (1.7% vs. 13.2%, p=0.000). In both time periods, imipenem was the antimicrobial agent showing the highest rate of susceptibility (93.3% vs. 93.9%, p=0.783). Higher prevalence of ESBL-producing E. coli and C. freundii was observed in the hospital-acquired cholangitis group (52.1% vs. 31.2%, p=0.000; 15.9% vs. 7.3%, p=0.001). CONCLUSIONS: The most common causative pathogen of acute cholangitis was ESBL-producing E. coli. Prevalence of C. freundii increased over the time period. Imipenem should be reserved as an alternative for resistant pathogens.
Acute Disease ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*pharmacology ; Cholangitis/diagnosis/*microbiology ; *Citrobacter freundii/drug effects/isolation & purification ; Community-Acquired Infections/microbiology ; Cross Infection/microbiology ; Drug Resistance, Bacterial ; *Escherichia coli/drug effects/isolation & purification ; Female ; Humans ; Imipenem/pharmacology ; *Klebsiella pneumoniae/drug effects/isolation & purification ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Retrospective Studies ; Time Factors ; beta-Lactamases/metabolism