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Gallstone disease. The clinical manifestations of infectious stones
1Surgical Service, Veterans Administration Medical Center, San Francisco, CA 94121.
Abstract:
Gallstones from 82 patients were examined under a scanning electron microscope for evidence of bacteria, and the findings were compared with the clinical manifestations of the disease. Bacteria were present in 68% of pigment stones and the pigment portions of 80% of composite stones. These gallstones were referred to as infectious stones. No bacteria were found in cholesterol gallstones. Acute cholangitis was diagnosed in 52% of patients with infectious stones and in 18% of patients with noninfectious stones. Over half of the patients with noninfectious stones presented with mild symptoms. Infectious stones were more often associated with a previous common duct exploration, an urgent operation, infected bile, a common duct procedure, and complications. These data show that gallstone disease is more virulent in patients whose gallstones contain bacteria.
Insights
Bacteria found in gallstones indicate an "infectious stone" diagnosis, leading to more severe symptoms and complications like acute cholangitis. Cholesterol gallstones were found to be bacteria-free.
Area of Science:
- Gastroenterology
- Microbiology
- Pathology
Background:
- Gallstones are a common condition, but the role of bacterial infection in their pathogenesis and clinical presentation is not fully understood.
- Previous studies have suggested a link between bacteria and certain types of gallstones, but comprehensive analysis is needed.
Purpose of the Study:
- To investigate the presence of bacteria in different types of gallstones using scanning electron microscopy.
- To correlate the findings of bacterial presence in gallstones with clinical manifestations and disease severity.
Main Methods:
- Scanning electron microscopy was used to examine gallstones from 82 patients for bacterial evidence.
- Clinical data, including symptoms and complications, were collected and compared between patients with infectious and noninfectious gallstones.
Main Results:
- Bacteria were detected in 68% of pigment stones and 80% of the pigment portions of composite stones, termed "infectious stones."
- No bacteria were found in cholesterol gallstones.
- Patients with infectious stones had a significantly higher incidence of acute cholangitis (52%) compared to those with noninfectious stones (18%).
- Infectious stones were associated with a history of common duct exploration, urgent operations, infected bile, and complications.
Conclusions:
- The presence of bacteria in gallstones defines them as "infectious stones" and is linked to more virulent gallstone disease.
- Cholesterol gallstones appear to be non-infectious.
- Identifying infectious gallstones is crucial for understanding disease severity and managing patient outcomes.