The bacteriology of cholelithiasis--China versus Japan

Cholelithiasis differs considerably from area to area in the world. Calcium bilirubinate stones or brown pigment stones are said to predominate in the Orient, however, this situation may differ within the Orient. In order to compare cases in China and Japan, 102 consecutive cases of cholelithiasis operated on in Shenyang, China were analyzed for the composition of gallstones and bacterial species isolated from bile in relation to the location and composition of gallstones. In Shenyang, calcium bilirubinate stones predominated, occurring in 49.0 per cent of the cholelithiasis cases. This was much higher than in Japan, which had 17.5 per cent. The incidence of bacteria was also very high, ranging from 20 to 96 per cent, with an average of 66.7 per cent depending on the kind of gallstone present. Bacterial species possessing beta-glucuronidase activity were present in nearly all the cases of calcium bilirubinate stones (92.0 per cent). The incidence of bacteria with beta-glucuronidase activity especially of E. coli was much higher than in Japan (50.8 per cent versus 21.8 per cent) in concordance with the higher incidence of calcium bilirubinate stones in China (49.0 versus 17.5 per cent).