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Pigment gallstones.

R D Soloway, B W Trotman, J D Ostrow

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    Pigment gallstones are dark, calcium bilirubinate stones found in the Orient and with cirrhosis. Their formation involves increased unconjugated bilirubin, calcium, and glycoproteins, with stasis playing a key role.

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    Area of Science:

    • Gastroenterology
    • Hepatology
    • Biochemistry

    Background:

    • Pigment gallstones are dark, calcium bilirubinate stones.
    • They are prevalent in the rural Orient, with cirrhosis, and in elderly patients undergoing cholecystectomy.
    • Associated factors include bile duct obstruction, stasis, and hemolysis.

    Purpose of the Study:

    • To define pigment gallstones and review their clinical associations.
    • To explore the biochemical and etiological factors in pigment gallstone formation.
    • To discuss current treatment options.

    Main Methods:

    • Literature review of pigment gallstone composition, associations, and formation.
    • Analysis of bile composition in patients with pigment stones.
    • Review of potential etiological factors including bacterial and physiological influences.

    Main Results:

    • Pigment stones consist of calcium salts of bilirubin, phosphate, and carbonate.
    • 50% are radioopaque, accounting for two-thirds of opaque stones.
    • Increased unconjugated bilirubin, calcium, and sulfated glycoproteins in bile are implicated in stone precipitation.
    • Bacterial beta-glucuronidase (E coli) may be significant in Japan but not the West.
    • Stasis and incomplete gallbladder emptying promote concentration of stone-forming components.

    Conclusions:

    • Pigment gallstone formation is multifactorial, involving biochemical changes and physiological stasis.
    • Increased unconjugated bilirubin and calcium are key components.
    • Surgery remains the primary treatment for pigment gallstones.