Gallstones can be classified into cholesterol stones and pigment stones which further can be divided into calcium bilirubinate stones and black pigment stones. Calcium bilirubinate stones differ from cholesterol stones not only in clinical
manifestations but also in composition. implying a difference in pathogenesis. The presence of β-glucuronidase. produced by bacteria, in bile may lead to an increased amount of unconjugated, water-insoluble bilirubin. which may precipitate as
calcium
bilirubinate. Another hypothesis is activation of glucuronidase produced in hepatocytes or leukocytes, which has been shown to be present in human bile.
To examine the role of bacterial β-glucuronidase activity in the pathogenesis of gallstone formation, we cultured the bile of the gallbladder and common bile duct obtained from 8 controls. 3 patients with cholesterol gallstone and 21 paeitns
with
calcium bilirubinate galistone and tested β-glucuronidase activity of isolated bactrial strains.
@ES The results obtained are as follows:
@EN The bacterial culture rate of bile obtained from patients with calcium bilirubinate stones were higher than that of bile obtained from patients with cholesterol stones. E. coli was the most common bacteria isolated from bile followed by
Klebsiella
pneumoniae, Klebsiella axytoca. Enterococcus fecalis, Clostridium perfringens. Enterococcus cloacae, and Citrobacter frundii. Most of the isolated E. Coli strains showed β-glucuronidase activity (92.9%). All 1 patients, from whose bile
β-glucuronidase
producing bacteria wer eisolated, ahd calcium bilirubinate stones. Ten of 11 pateitns (90.9%), from whose bile β-glucuronidase producing bacteria were isolated, had bile duct stones.
From these results, we concluded that β-glucuronidase producing bacterial infections of bile may be related with the pathogenesis of calcium bilirubinate stone formation.
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