Pancreaticobiliary reflux in patients with and without cholelithiasis: is it a normal phenomenon?

Pancreaticobiliary reflux is a pathologic phenomenon occurring in patients with gallstones. However, the occurrence of pancreaticobiliary reflux has not been studied in patients without gallstones. The objective of the present study was to measure the bile levels of amylase and lipase in patients without gallstones submitted to cholecystectomy as part of another surgical procedure, and to compare these values with the bile levels of amylase and lipase of patients submitted to cholecystectomy for gallstone disease.

A prospective observational and comparative study was designed. A sample of 136 consecutive patients was included. Amylase and lipase levels were measured in bile. At our institution, normal plasma concentrations of amylase are 28-100 IU/l and lipase 13-60 IU/l. Normal values for pancreatic enzyme concentrations in bile have not been established. Therefore, bile amylase and lipase concentrations exceeding normal plasma concentrations were deemed to be elevated.

Of the patients in the present study, 103 (76%) had gallstones and 33 (24%) had healthy gallbladders without gallstones. According to normal plasma levels for amylase and lipase, these enzymes in bile were elevated in 83.5% patients with gallstones, compared to elevated levels of amylase in 6% patients and lipase in 3% patients without gallstones (P < 0.0001).

Pancreaticobiliary reflux is a common phenomenon in patients with gallstones and an uncommon phenomenon in patients with healthy gallbladders without gallstone disease.