Gallstone formation is the result of a complex interaction between genetic and nongenetic factors. We searched and reviewed the available literature to define how the primary prevention of gallstones (cholesterol gallstones in particular) could be applied in general practice. Electronic bibliographical databases were searched. Prospective and retrospective cohort studies and case-controlled studies were analyzed and graded for evidence quality. The epidemiological data confirmed that genetic factors are estimated to account for only approximately 25% of the overall risk of gallstones, while metabolic/environmental factors are at least partially modifiable in stone-free risk groups, and are thus modifiable by primary prevention measures related to diet, lifestyle, and environmental factors (i.e., rapid weight loss, bariatric surgery, somatostatin or analogues therapy, transient gallbladder stasis, and hormone therapy). There is no specific recommendation for the secondary prevention of recurrent gallstones. Family physicians can contribute to preventing gallstones due to their capability to identify and effectively manage several risk factors discussed in this study. Although further studies are needed to better elucidate the involvement of epigenetic factors that may regulate the effect of environment and lifestyle on gene expression in the primary prevention of gallstone formation, preventive interventions are feasible and advisable in the general practice setting.
Bariatric Surgery ; Bile Acids and Salts ; Case-Control Studies ; Cohort Studies ; Diet ; Epigenomics ; Gallbladder ; Gallstones* ; Gene Expression ; General Practice ; Humans ; Life Style ; Mental Competency* ; Obesity ; Physicians, Family* ; Primary Prevention ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Secondary Prevention ; Somatostatin ; Weight Loss

To observe the effect of various doses of oil of Piper longum unsaponifiable matter (OPUM) to cholesterol gallstones in experimental mice. C57BL/6 mice (n = 60) were randomly divided into 6 groups: control group, model group, OPUM (15, 30 and 60 mg x kg(-1)) group and ursodeoxycholic acid (UDCA, 60 mg x kg(-1)) group, administered for 10 weeks. The level of serum lipid and liver function enzymes were tested. The gallbladder was removed and bile was obtained by centrifugation. Next, the levels of the bile total cholesterol (TC), phospholipid (PL) and bile acid (TBA) were measured. The indicators of lipid peroxidation were determined and cholesterol saturation index (CSI) was calculated. The liver histological changes were observed by HE staining. The results showed that serum TC, TG (triglycerides) and AST (aspartate transaminase) contents, gallbladder cholesterol crystallization and CSI increased significantly (P < 0.05). In addition, the activity of SOD decreased significantly and MDA content increased significantly in liver (P < 0.05). HE staining results showed that the hepatic cord disorder and intracellular lipid droplets increased significantly. All results indicate that lithogenic diet lead to the formation of cholesterol gallstones. In OPUM (30 and 60 mg x kg(-1)) group, serum TC, TG and AST content, gallbladder cholesterol crystallization and CSI decreased significantly, the activity of SOD increased significantly and MDA content decreased significantly. HE staining results showed that OPUM can improve the morphology of liver cell, reduce the degree of hepatic cord disorders and restore the cell morphology close to normal. The cause of OPUM prevents cholesterol gallstone formation maybe due to protect the integrity of the liver cells, lower CSI, and reduce cholesterol crystal formation and hence prevent cholesterol gallstone formation.
Animals ; Aspartate Aminotransferases ; blood ; Bile ; chemistry ; Cholesterol ; blood ; Gallbladder ; Gallstones ; metabolism ; prevention & control ; Liver ; metabolism ; pathology ; Male ; Malondialdehyde ; metabolism ; Mice ; Mice, Inbred C57BL ; Piper ; chemistry ; Plant Oils ; isolation & purification ; pharmacology ; Plants, Medicinal ; chemistry ; Random Allocation ; Superoxide Dismutase ; metabolism ; Triglycerides ; blood

BACKGROUND/AIMS: We aimed to explore the risk factors contributing to the recurrence of common bile duct (CBD) stones after successful endoscopic stone clearance, focused on the anatomical factors of CBD and presence or absence of ursodeoxycholic acid (UDCA)/Rowachol(R) medication. METHODS: One hundred fourteen patients who underwent CBD stone(s) extraction by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy at our institution from August 2004 to January 2007 were included. Univariate and multivariate analyses for the risk factors including the distal CBD angle, length of the distal CBD arm and medication such as ursodeoxycholic acid (UDCA) and/or Rowachol(R) for recurrent CBD stone(s) were performed. RESULTS: The recurrence of CBD stone(s) was found in 22 (19.3%) patients. On univariate analysis, presence of pneumobilia, presence of type 1 or type 2 periampullary diverticulum, mechanical lithotripsy and multiple sessions of ERCP were significant contributors for the recurrence of CBD stone(s). On multivariate analysis, the presence of type 1 periampullary diverticulum (OR 7.90, 95% CI: 1.56-40.16) and multiple sessions of ERCP (OR 7.56, 95% CI: 2.21-25.87) were significant contributors. Acute distal CBD angulation (< or =135degrees), shorter distal CBD arm (< or =36 mm), technical difficulty of CBD stone(s) clearance, and the prescription of UDCA and/or Rowachol(R) were not significantly associated with the recurrence of CBD stone(s). CONCLUSIONS: The recurrence of CBD stone(s) was more commonly found in the patients group with type 1 periampullary diverticulum and multiple sessions of ERCP. Therefore, patients with these risk factors should be on regular follow up.
Aged ; Cholangiopancreatography, Endoscopic Retrograde ; *Common Bile Duct/radiography ; Data Interpretation, Statistical ; Female ; Gallstones/prevention & control/radiography/*surgery ; Humans ; Male ; Middle Aged ; Prospective Studies ; Recurrence ; Risk Factors ; *Sphincterotomy, Endoscopic ; Treatment Outcome ; Ursodeoxycholic Acid/pharmacology

Obesity is an important health problem in the world and related to many critical diseases, such as diabetes, cardiovascular disease, and metabolic syndrome. Obesity leads to fat infiltration of multiple organs and infiltrated adipose tissue produces many cytokines resulting in the dysfunction of organs such as the gallbladder. In the biliary diseases, obesity and overweight have been known as a major risk factor for gallstones. According to current studies, obesity, insulin resistance, hyperinsulinemia, and metabolic syndrome are related to various gallbladder diseases including gallbladder stones, cholecystitis, gallbladder polyps, and gallbladder cancers. We reviewed further literature on the obesity and gallbladder diseases, in aspects of epidemiology, mechanism, pathology and prevention.
Body Mass Index ; Cholecystitis/etiology ; Exercise ; Gallbladder Diseases/drug therapy/epidemiology/*etiology/prevention & control ; Gallbladder Neoplasms/epidemiology/etiology ; Gallstones/epidemiology/etiology ; Humans ; Hyperinsulinism ; Hypolipidemic Agents/therapeutic use ; Insulin Resistance ; Obesity/*complications ; Ursodeoxycholic Acid/therapeutic use ; Weight Loss