Indian Journal of Surgery

, Volume 77, Supplement 2, pp 376–380 | Cite as

Gallstone Classification in Western Countries

Original Article

Abstract

In order to compare gallstone disease data from India and Asian countries with Western countries, it is fundamental to follow a common gallstone classification. Gallstone disease has afflicted humans since the time of Egyptian kings, and gallstones have been found during autopsies on mummies. Gallstone prevalence in adult population ranges from 10 to 15 %. Gallstones in Western countries are distinguished into the following classes: cholesterol gallstones that contain more than 50 % of cholesterol (nearly 75 % of gallstones) and pigment gallstones that contain less than 30 % of cholesterol by weight, which can be subdivided into black pigment gallstones and brown pigment gallstones. It has been shown that ultrastructural analysis with scanning electron microscopy is useful in the classification and study of pigment gallstones. Moreover, x-ray diffractometry analysis and infrared spectroscopy of gallstones are of fundamental importance for an accurate stone analysis. An accurate study of gallstones is useful to understand gallstone pathogenesis. In fact, bacteria are not important in cholesterol gallstone nucleation and growth, but they are important in brown pigment gallstone formation. On the contrary, calcium bilirubinate is fundamental in black pigment gallstone formation and probably also plays an important role in cholesterol gallstone nucleation and growth.

Keywords

Gallstone classification Cholesterol gallstones Black pigment gallstones Brown pigment gallstones 

Notes

Conflict of Interest

The author states that there is no conflict of interest and that no funds were received for this study.

References

  1. 1.
    Jarrar BM, Al-Rowaili MA (2011) Chemical composition of gallstones from Al-Jouf Province of Saudi Arabia. Malays J Med Sci 18(2):47–52PubMedPubMedCentralGoogle Scholar
  2. 2.
    Kawai M, Iwahashi M, Uchiyama K, Ochiai M, Tanimura H, Yamaue H (2002) Gram-positive cocci are associated with the formation of completely pure cholesterol stones. Am J Gastroenterol 97(1):83–88PubMedCrossRefGoogle Scholar
  3. 3.
    Cariati A, Cetta F, Re-Kawai et al (2002) Bacteria are not important in the formation of pure cholesterol stones. Am J Gastroenterol 97(11):2921–2922PubMedGoogle Scholar
  4. 4.
    Shaffer EA (2005) Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 7:132–140PubMedCrossRefGoogle Scholar
  5. 5.
    Portincasa P, Moschetta A, Palasciano G (2006) Cholesterol gallstone disease. Lancet 368(9531):230–239PubMedCrossRefGoogle Scholar
  6. 6.
    Diehl AK (1991) Epidemiology and natural history of gallstone disease. Gastroenterol Clin North Am 20(1):1–19PubMedGoogle Scholar
  7. 7.
    Ostrow JD (1984) The etiology of pigment gallstones. Hepatology 4:215S–222SPubMedCrossRefGoogle Scholar
  8. 8.
    Maki T (1966) Pathogenesis of calcium bilirubinate gallstone: role of E. coli, beta-glucuronidase, and coagulation by inorganic ions, polyelectrolytes, and agitation. Ann Surg 164:90–100PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Cetta F (1986) Bile infection documented as initial event in the pathogenesis of brown pigment biliary stones. Hepatology 6:482–489PubMedCrossRefGoogle Scholar
  10. 10.
    Malet PF, Takabajashi A, Trotman BW et al (1984) Black and brown pigment gallstones differ in microstructure and microcomposition. Hepatology 4:227–234PubMedCrossRefGoogle Scholar
  11. 11.
    Soloway RD, Trotman BW, Maddrey WC, Nakayama F (1986) Pigment gallstone composition in patients with hemolysis or infection/stasis. Dig Dis Sci 31:454–460PubMedCrossRefGoogle Scholar
  12. 12.
    Cariati A, Piromalli E (2012) Limits and perspective of oral therapy with statins and aspirin for the prevention of symptomatic cholesterol gallstone disease. Expert Opin Pharmacother 13(9):1223–1227PubMedCrossRefGoogle Scholar
  13. 13.
    Cariati A, Piromalli E (2012) Ultrastructural basis of the failure of oral dissolution therapy with bile salts and /or statin for cholesterol gallstone. Expert Opin Pharmacother 13(9):1387–1388PubMedCrossRefGoogle Scholar
  14. 14.
    Malet PF, Dabazies MA, Huang G et al (1988) Quantitative infrared spectroscopy of common bile duct gallstones. Gastroenterology 94:1217–1221PubMedGoogle Scholar
  15. 15.
    Sutor DJ, Wooley SE (1973) The nature and incidence of gallstones containing calcium. Gut 14:215–220PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Cetta F (1991) The role of bacteria in pigment gallstone disease. Ann Surg 213(4):315–326PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Cariati A, Cetta F (2003) Rokitansky–Aschoff sinuses of the gallbladder are associated with black pigment gallstone formation: a scanning electron microscopy study. Ultrastruct Pathol 27:265–270PubMedCrossRefGoogle Scholar
  18. 18.
    Vitek L, Carey MC (2012) New pathophysiological concepts underlying pathogenesis of pigment gallstones. Clin Res Hepatol Gastroenterol 36:122–129PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Cariati A, Traverso E (2003) Ultrastructural analysis and classification of pigment gallstones. J Lab Clin Med 142(6):431–432PubMedCrossRefGoogle Scholar
  20. 20.
    Cariati A, Piromalli E (2012) Prevention of biliary stent occlusion. Dig Dis Sci 57(7):1971–1972. doi: 10.1007/s10620-012-2109-4 PubMedCrossRefGoogle Scholar
  21. 21.
    Cariati A, Piromalli E (2012) Role of parietal (gallbladder mucosa) factors in the formation of black pigment gallstones. Clin Res Hepatol Gastroenterol 36:e50–e51PubMedCrossRefGoogle Scholar
  22. 22.
    Cariati A, Cetta F (2003) Squamous cell and nonsquamous cell carcinomas of the gallbladder have different risk factors. Lancet Oncol 4:393–394Google Scholar
  23. 23.
    Cariati A, Piromalli E (2012) Chemotherapy and histological stratification of biliary tract cancers. Oncology 82:352–353PubMedCrossRefGoogle Scholar
  24. 24.
    Cariati A (2010) Cisplatin plus gemcitabine for biliary tract cancer. New Engl J Med 363(2):192PubMedCrossRefGoogle Scholar
  25. 25.
    Cariati A, Puglisi R, Zaffarano R, Accarpio FT, Cetta F (2003) Helicobacter pylori and the risk of benign and malignant biliary tract disease. Cancer 98:656–657PubMedCrossRefGoogle Scholar
  26. 26.
    Behari A, Kapoor VK (2012) Asymptomatic gallstones—to treat or not to? Indian J Surg 74:4–12PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Cariati A, Piromalli E (2012) Is preventive cholecystectomy for gallbladder carcinoma in Northern India cost effective? Indian J Surg. doi: 10.1007/s12262-012-0601-x
  28. 28.
    Cariati A (2012) Blackberry pigment (whitlockite) gallstones in uremic patients. Clin Res Hepatol Gastroenterol. doi: 10.1016/j.clinre.2012.08.004

Copyright information

© Association of Surgeons of India 2013

Authors and Affiliations

  1. 1.General Surgery, San Martino, ISTUniversity HospitalGenoaItaly

Personalised recommendations