Skip to main content
SpringerLink
Log in

Pancreaticobiliary Reflux in Patients with and without Cholelithiasis: Is It a Normal Phenomenon?

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

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.

Patients and methods

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.

Results

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).

Conclusions

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sai JK, Suyama M, Kubokawa Y et al (2003) Occult pancreaticobiliary reflux in patients with a normal pancreaticobiliary junction. Gastrointest Endosc 57:364–368

    Article  PubMed  Google Scholar 

  2. Horaguchi J, Fujita N, Noda Y et al (2008) Amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement. J Gastroenterol 43:305–311

    Article  CAS  PubMed  Google Scholar 

  3. Kamisawa T, Okamoto A (2006) Biliopancreatic and pancreaticobiliary refluxes in cases with and without pancreaticobiliary maljunction: diagnosis and clinical implications. Digestion 73:223–236

    Article  Google Scholar 

  4. Beltrán MA, Vracko J, Cumsille MA et al (2007) Occult pancreaticobiliary reflux in gallbladder cancer and benign gallbladder diseases. J Surg Oncol 96:26–31

    Article  PubMed  Google Scholar 

  5. Mizuno M, Kato T, Koyama K (1996) An analysis of mutagens in the contents of the biliary tract in pancreaticobiliary maljunction. Surg Today 26:597–602

    Article  CAS  PubMed  Google Scholar 

  6. Ito T, Tsuchida A, Itokawa F et al (2005) Histologic and genetic analysis of the gallbladder in patients with occult pancreaticobiliary reflux. Int J Mol Med 15:425–430

    Google Scholar 

  7. Sai JK, Suyama M, Nobukawa B et al (2005) Precancerous mucosal changes in the gallbladder of patients with occult pancreaticobiliary reflux. Gastrointest Endosc 61:264–268

    Article  PubMed  Google Scholar 

  8. Sai JK, Suyama M, Kubokawa Y (2006) A case of gallbladder carcinoma associated with pancreaticobiliary reflux in the absence of pancreaticobiliary maljunction: a hint for early diagnosis of gallbladder carcinoma. World J Gastroenterol 28:4593–4595

    Google Scholar 

  9. Inagaki M, Goto J, Suzuki S et al (2007) Gallbladder carcinoma associated with occult pancreaticobiliary reflux in the absence of pancreaticobiliary maljunction. J Hepatobiliary Pancreat Surg 14:529–533

    Article  PubMed  Google Scholar 

  10. Sai JK, Suyama M, Nobukawa B et al (2005) Severe dysplasia of the gallbladder associated with occult pancreaticobiliary reflux. J Gastroenterol 40:756–760

    Article  PubMed  Google Scholar 

  11. Lenriot JP, Gigot JF, Segol P et al (1998) Bile duct cysts in adults: a multi-institutional retrospective study. Ann Surg 228:159–166

    Article  CAS  PubMed  Google Scholar 

  12. Kimura K, Ohto M, Ono T et al (1977) Congenital cystic dilatation of the common bile duct: relationships to anomalous pancreaticobiliary ductal union. AJR Am J Roentgenol 128:571–577

    CAS  PubMed  Google Scholar 

  13. McKee MD (2007) Pancreaticobiliary reflux and gallbladder cancer. J Surg Oncol 96:455–456

    Article  PubMed  Google Scholar 

  14. Anderson MC, Hauman RL, Suriyapa C et al (1979) Pancreatic enzymes levels in bile of patients with extrahepatic biliary disease. Am J Surg 137:301–306

    Article  CAS  PubMed  Google Scholar 

  15. Vracko J, Wiechel KL (2003) Increased gallbladder trypsin in acute cholecystitis indicates functional disorder in the sphincter of Oddi and could make EPT a logical procedure. Surg Laparosc Endosc Percutan Tech 13:308–313

    Article  PubMed  Google Scholar 

  16. Itokawa F, Itoi T, Nakamura K et al (2004) Assessment of occult pancreaticobiliary reflux in patients with pancreaticobiliary disease by ERCP. J Gastroenterol 39:988–994

    Article  PubMed  Google Scholar 

  17. Beltrán MA, Barría C (2007) Heterotopic pancreas in the gallbladder—the importance of an uncommon condition. Pancreas 34:488–491

    Article  PubMed  Google Scholar 

  18. Ko CW, Schulte SJ, Lee SP (2005) Biliary sludge is formed by modification of hepatic bile by the gallbladder mucosa. Clin Gastroenterol Hepatol 3:672–678

    Article  CAS  PubMed  Google Scholar 

  19. Tazuma S, Kajiyama G (2001) Carcinogenesis of malignant lesions of the gallbladder—the impact of chronic inflammation and gallstones. Langenbecks Arch Surg 386:224–229

    Article  CAS  PubMed  Google Scholar 

  20. Chao TC, Wang CS, Jan YY et al (1999) Carcinogenesis in the biliary system associated with APDJ. J Hepatobiliary Pancreat Surg 6:218–222

    Article  CAS  PubMed  Google Scholar 

  21. Masumoto Y, Fujii H, Itakura J et al (2003) Pancreaticobiliary maljunction: pathophysiological and clinical aspects and the impact in biliary carcinogenesis. Langenbecks Arch Surg 388:122–131

    Google Scholar 

  22. Funabiki T, Matsubara T, Miyakawa S et al (2009) Pancreaticobiliary maljunction and carcinogenesis to biliary and pancreatic malignancy. Langenbecks Arch Surg 394:159–169

    Article  PubMed  Google Scholar 

  23. Cicala M, Habib FI, Fiocca F et al (2001) Increased sphincter of Oddi basal pressure in patients affected by gallstone disease: a role for biliary stasis and colicky pain? Gut 48:414–417

    Article  CAS  PubMed  Google Scholar 

  24. Tanaka M, Ikeda S, Kawakami K et al (1982) The presence of a positive pressure gradient from pancreatic to choledochal cyst demonstrated by duodenoscopic micro-transducer manometry: clue to pancreaticobiliary reflux. Endoscopy 14:45–47

    Article  CAS  PubMed  Google Scholar 

  25. Vracko J, Markovic S, Wiechel KL (2006) Conservative treatment versus endoscopic sphincterotomy in the management of acute cholecystitis in elderly patients at surgical risk. Endoscopy 38:773–778

    Article  CAS  PubMed  Google Scholar 

  26. Vracko J, Zemva Z, Pegan V et al (1994) Sphincter of Oddi function studied by radioimmunoassay of biliary trypsin in patients with bile duct stones and in controls. Surg Endosc 8:389–392

    Article  CAS  PubMed  Google Scholar 

  27. Vracko J, Wiechel KL (2000) Trypsin level in gallbladder bile and ductitis and width of the cystic duct. Hepatogastroenterology 47:115–120

    CAS  PubMed  Google Scholar 

  28. Hjorth E (1947) Contributions to the knowledge of pancreatic reflux as a factor in chronic affections of the gallbladder. Acta Chir Scand 96:12–29

    Google Scholar 

  29. Tzovaras G, Rowlands BJ (1988) Diagnosis and treatment of sphincter of Oddi dysfunction and other functional biliary disorders. Br J Surg 85:588–595

    Article  Google Scholar 

  30. Eversman D, Fogel EL, Rusche M et al (1999) Frequency of abnormal pancreatic and biliary sphincter manometry compared with clinical suspicion of sphincter of Oddi dysfunction. Gastrointest Endosc 50:637–641

    Article  CAS  PubMed  Google Scholar 

  31. Petersen BT (2004) An evidence-based review of sphincter of Oddi dysfunction: part I, presentations with “objective” biliary findings (types I and II). Gastrointest Endosc 59:525–534

    Article  PubMed  Google Scholar 

  32. Prajapati DN, Hogan WJ (2003) Diagnosis and treatment of sphincter of Oddi dysfunction. Gastroenterol Clin North Am 32:601–618

    Article  PubMed  Google Scholar 

  33. Yokohata K, Tanaka M (2000) Cyclic motility of the sphincter of Oddi. J Hepatobiliary Pancreat Surg 7:178–182

    Article  CAS  PubMed  Google Scholar 

  34. Tanaka M (2002) Advances in research and clinical practice in motor disorders of the sphincter of Oddi. J Hepatobiliary Pancreat Surg 9:564–568

    Article  PubMed  Google Scholar 

  35. Canfield AJ, Hetz SP, Schriver JP et al (1998) Biliary dyskinesia: a study of more than 200 patients and review of the literature. J Gastrointest Surg 2:443–448

    Article  CAS  PubMed  Google Scholar 

  36. Amaral J, Xiao ZL, Chen Q et al (2001) Gallbladder muscle dysfunction in patients with chronic acalculous disease. Gastroenterology 120:506–511

    Article  CAS  PubMed  Google Scholar 

  37. Chen PF, Nimeri A, Pham QH et al (2001) The clinical diagnosis of chronic acalculous cholecystitis. Surgery 130:578–583

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work is registered as Clinicaltrials.Gov—Protocol Registration System—Nct00890201.

Author information

Authors and Affiliations

  1. Department of Surgery, Hospital de la Serena, P.O. Box 912, La Serena, IV Región, Chile

    Marcelo A. Beltrán & Karina S. Cruces

  2. Balmaceda 916, La Serena, IV Región, Chile

    Mario A. Contreras

Authors
  1. Marcelo A. Beltrán
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mario A. Contreras
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karina S. Cruces
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcelo A. Beltrán.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beltrán, M.A., Contreras, M.A. & Cruces, K.S. Pancreaticobiliary Reflux in Patients with and without Cholelithiasis: Is It a Normal Phenomenon?. World J Surg 34, 2915–2921 (2010). https://doi.org/10.1007/s00268-010-0771-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-010-0771-2

Keywords

Search

Navigation