What causes cholelithiasis?

Factors predisposing to the formation of gallstones (primarily cholesterol):

The role of infection

Although it is believed that infection does not play a significant role in the formation of cholesterol stones, with the help of polymerase chain reaction, bacterial DNA is found in stones containing less than 90% cholesterol. Probably, bacteria are able to deconjugate the gallstones, as a result of which the bile acids are absorbed and the solubility of cholesterol is reduced.

With the infection of the bile ducts, the formation of brown pigmented stones is associated, in most of which electron microscopy is detected by bacteria.

Female

In women, especially under the age of 50, gallstones occur twice as often as men.

Multiple women fall ill more often than nulliparous women. Incomplete emptying of the gallbladder at late pregnancy leads to an increase in its residual volume, the accumulation of cholesterol crystals and, as a consequence, the formation of gallstones. During pregnancy, often find a yellow putty, which is usually not manifested clinically and spontaneously resolved after giving birth to two thirds of women. In the postpartum period, gallstones were found in 8-12% of cases (9 times more often than in the corresponding control group). A third of women who had gallstones found against the background of a functioning gallbladder showed characteristic symptoms of the disease. Small stones disappeared independently in 30% of cases.

Oral contraceptives lead to an increase in the lithogenic properties of bile. With prolonged intake of oral contraceptives, diseases of the gallbladder develop 2 times more often than in the control group. The use of estrogen-containing drugs in postmenopause significantly (by 2.5 times) increases the incidence of cholelithiasis. An increase in the saturation of bile cholesterol and the occurrence of gallstones in men who received estrogens for prostate cancer were noted. Estrogen and progesterone receptors were found in the wall of the human gallbladder.

Age

Aging is associated with increased formation of gallstones, possibly due to an increase in the cholesterol content in bile. By age 75, 20% of men and 35% of women have gallstones, which usually manifest clinically after 50-60 years.

It was reported about the detection of pigment and cholesterol stones in children.

Genetic and ethnic characteristics

Regardless of age, body weight and nutritional status, gallstones are common in relatives of patients with gallstone disease more often than in the general population. This figure is 2-4 times higher than expected values.

Nature of food - excessive consumption of fatty foods with a high content of cholesterol, animal fats, sugar, sweets;

In Western countries, the formation of gallstones is associated with a low fiber content in food and a longer passage of food through the gastrointestinal tract. This leads to an increase in the concentration of bile in the secondary bile acids, for example, deoxycholic, which makes bile more lithogenic. Purified carbohydrates increase the saturation of bile with cholesterol, while small doses of alcohol have the opposite effect. In vegetarians, regardless of body weight, gallstones are less common.

An increase in the intake of cholesterol with food increases its content in the bile, but there are no epidemiological or dietary data linking the intake of cholesterol with the formation of gallstones. Endogenous cholesterol is probably the main source of bile cholesterol.

Pregnancy (multiple births in anamnesis)

Obesity

Obviously, obesity is more common among patients with cholelithiasis than in the general population, being an important risk factor in women younger than 50 years. Obesity is accompanied by an increase in the synthesis and excretion of cholesterol, but is not associated with characteristic changes in the residual volume of the gallbladder after ingestion. In 50% of patients with severe obesity, gallstones are found in abdominal operations.

Low-calorie diets (2100 kJ per day) in patients with obesity can lead to the formation of gallstones with a characteristic symptomatology, as well as bile putty. It is noted that weight loss is associated with an increase in the content of the gallbladder mucin and calcium. To prevent the formation of gallstones with rapid reduction in body weight after shunting operations on the stomach use ursodeoxycholic acid.

Serum factors

The most important risk factors for the occurrence of gallstones, both cholesterol and pigmental, perhaps even more important than body weight, are low levels of high-density lipoproteins and high triglycerides. A high concentration of cholesterol in the serum does not affect the risk of gallstones.

Other factors

Resection of the ileum disrupts enterohepatic circulation of bile salts, reduces their pool and leads to the formation of gallstones. Similar changes occur with subtotal and total colectomy.

After gastrectomy, gallstones are formed more often.

Prolonged intake of cholestyramine increases the loss of bile salts, leading to a decrease in the total pool of bile acids and cholelithiasis.

Low-cholesterol diets rich in unsaturated fats and plant sterols, but poor in saturated fats and cholesterol, cause cholelithiasis.

Treatment with clofibrate increases the excretion of cholesterol and increases the lithogenicity of bile.

With parenteral nutrition, there is an expansion and hypokinesia of the gallbladder containing stones.

Long-term treatment with octreotide causes cholelithiasis in 13-60% of patients with acromegaly. At the same time there is oversaturation of bile cholesterol, unusually short deposition time and high cholesterol content in the stones. In addition, the emptying of the gallbladder is disturbed.