Pereira, Stephen Paul; (2002) The pathogenesis and non-surgical treatment of gallstones : Clinical and laboratory studies. Doctoral thesis (Ph.D.), University College London (United Kingdom).

Text The_pathogenesis_and_non-surgi.pdf Download (18MB)

Abstract

Background: Gallstone disease is common and affects between 10% and 20% of the world's population. This thesis addresses selected aspects of the non-surgical treatment of patients with symptomatic gallbladder stones, and the pathogenesis of primary and recurrent gallstone formation. Methods: Pretreatment gallstone characteristics that predict the speed and completeness of non-surgical treatments were analysed, together with the reasons for non-response in patients with incomplete gallstone dissolution, and the composition of recurrent gallstones. In three distinct patient groups with, or at risk of developing, gallstones, various aspects of bile composition were also examined: i) bile physical chemistry and cholesterol microcrystal nucleation times in patients with 'conventional' cholesterol-rich gallstone disease, before and after successful medical dissolution therapy, (ii) the effects of octreotide on biliary phospholipid and mucin glycoprotein concentrations in paired, before and during treatment studies in acromegalic patients, and (iii) alterations in plasma and biliary phospholipids, biliary bile acids and non-mucin glycoproteins, in patients with active inflammatory bowel disease or following bowel resection. Results and Discussion: In patients with gallbladder stones undergoing medical dissolution therapy, the pretreatment computed tomography attenuation score predicted both the speed and completeness of gallstone dissolution. Irrespective of the original gallstone composition, recurrent stones were usually cholesterol-rich. Gallbladder bile from acromegalic patients treated with octreotide had multiple abnormalities of bile composition that were comparable with those seen in conventional cholesterol gallstone disease, with increases in biliary deoxycholic acid, arachidonic acid-rich phospholipids, mucin glycoprotein and cholesterol saturation - supporting the hypothesis that a rise in biliary deoxycholic acid, secondary to prolongation of intestinal transit and/or impaired gallbladder emptying, leads to the formation of lithogenic bile and cholesterol-rich gallstones. In contrast, in patients with ileal disease/resection, the presence of high biliary bilirubin concentrations and low % deoxycholic acid may favour the formation of mixed, pigment-rich gallstones.

Download activity - last month

Export as XMLCSVJSON

Download activity - last 12 months

Export as XMLCSVJSON

Downloads by country - last 12 months

Export as CSVXMLJSON

Archive Staff Only

View Item