Abstract
Two hundred consecutive gallstone cases have been subjected to bacteriological study employing improved anaerobic culture techniques. In addition toClostridia species, species of anaerobes such asBacteroides fragilis, Peptococcus, Veillonella, andEubacterium are found to be present, some of which possessed β-glucuronidase activity. This finding has a certain bearing on the etiology of bile pigment calcium stones. In addition toEscherichia coli, Bacteroides andClostridium often found in the biliary tract may contribute to the formation of bile pigment calcium stones by producing β-glucuronidase and thus deconjugating bilirubin diglucuronide to form free unconjugated bilirubin which in turn combines with calcium, leading to stone formation. In contrast, very low bacterial incidence was associated with cholesterol stones and so-called black stones—sometimes called pure pigment stones- and thus bacteria play little role, if any, in their formation. Therefore, bile pigment calcium stones and so-called black stones, which are often classified as pigment stones indiscriminately, should be differentiated not only because of their difference in their appearance and composition but also in their etiological background. Regardless of the kind of stones present in the common duct, the incidence of bacteria was found to be increased.
References
Rains AJH: Gallstones, Causes and Treatment. London, W. Heineman Medical Books, 1964
Miyake H, Johnston CG: Gallstones: Etiological studies. Digestion 1:219–228, 1968
Nakayama F: Studies on calculus versus milieu: Gallstone and bile. J Lab Clin Med 77:366–377, 1971
Suzuki N: On black pigment of gallstones with special reference to difference from melanins. Tohoku J Exp Med 85:238–247, 1965
Koga A, Todo S: Structure study of so-called black gallstones. Nihon Shokakibyo Gakukai Zasshi (Jpn J Gastroenterol) 74:1154–1159, 1977 (in Japanese with English summary)
Maki T: Pathogenesis of calcium bilirubinate gallstone: Role ofE. coli, β-glucuronidase and coagulation by inorganic ions, polyelectrolytes and agitation. Ann Surg 164:90–100, 1966
Drasar BS, Hill HJ: Human Intestinal Flora. New York, Academic press, 1974
Finegold SM: Anaerobic Bacteria in Human Disease. New York, Academic Press, 1977
Sakazaki R, Namioka S, Osada A, Yamada C: A problem on the pathogenic role of citrobacter of enteric bacteria. Jpn J Exp Med 30:13–22, 1960
Mitsuoka T, Sega T, Yamamoto S: Eine verbesserte Methodik der qualitativen und quantitativen Analyse der Darmflora von Menschen und Tieren. Zentralbl Bakteriol Parasitenk I Abt Orig 195:455–469, 1965
Wren MWD: The culture of clinical specimens for anaerobic bacteria: A comparison of three regimens. J Med Microbiol 10:195–201, 1977
Holdeman LV, and Moor WEC (eds): Anaerobe Laboratory Manual Blacksburg, Virginia, VPl Anaerobe Laboratory, Virginia Polytechnic Institute, State University 1977
Cowan ST: Cowan and Steel's Manual for the Identification of Medical Bacteria, 2nd ed. Cambridge University Press, Cambridge, 1974
Nakayama F: Quantitative microanalysis of gallstones. J Lab Clin Med 72:602–611, 1968
Kato K, Yoshida K, Tsukamoto H, Nobunaga M, Masuya T, Sawada T: Synthesis ofp-nitrophenyl-β-d-glucopyranosiduronic acid and its utilization as a substrate. Chem Pharm Bull (Tokyo) 8:239–242, 1960
Goodhart GL, Levison ME, Trotman BW, Soloway RD: Pigment vs cholesterol cholelithiasis. Bacteriology of gallbadder stone, bile, and tissue correlated with biliary lipid analysis. Am J Dig Dis 23:877–882, 1978
Ostrow JD, Murphy NM: Isolation and properties of conjugated bilirubin from bile. Biochem J 120:311–327, 1970
Yamauchi H, Onizuka A, Fukuda M, Saito T, Goto A: Factors affecting β-glucuronidase activity in bile of cholelithiasis cases. Nihon Shokakibyo Gakukai Zasshi (Jpn J Gastroenterol) 77:553, 1980 (abstract) (in Japanese)
England DM, Rosenblatt JE: Anaerobes in human biliary tracts. J Clin Microbiol 6(5):494–498, 1977
Bourgault AM, England DM, Rosenblatt JE, Forgacs P, Bieger RC: Clinical characteristics of anaerobic bactibilia. Arch Intern Med 139:1346–1349, 1979
Cox JL, Helfrich LR, Pass HI, Osterhaut S, Shingleton WW: The relationship between biliary tract infections and postoperative complications. Surg Gynecol Obstet 146:233–236, 1978
Nakayama F, Miyake H: Changing state of gallstone disease in Japan. Am J Surg 120:794–799, 1970
Soloway RD, Trotman BW, Ostrow JD: Pigment gallstones. Gastroenterology 72:167–182, 1977
Musa BU, Doe RP, Seal US: Purification and properties of human liver β-glucuronidase. J Biol Chem 240(7):2811–2816, 1965
Himeno M, Nishimura Y, Tsuji H, Kato K: Purification and characterization of microsomal and lysosomal β-glucuronidase from rat liver by use of immunoaffinity chromatography. Eur J Biochem 70:349–359, 1976
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tabata, M., Nakayama, F. Bacteria and gallstones. Digest Dis Sci 26, 218–224 (1981). https://doi.org/10.1007/BF01391633
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01391633