Impaired gallbladder mucosal function in aged gallstone patients suppresses gallstone recurrence after successful extracorporeal shockwave lithotripsy.
BACKGROUND
Absorption of water, as well as emptying of bile, are important functions of the gallbladder. We studied the changes of gallbladder function with age in gallstone patients and their influence on the outcome of extracorporeal shockwave lithotripsy (ESWL).


METHODS
(i) A total of 123 consecutive patients with complete stone clearance by ESWL were examined. Gallbladder emptying was assessed before treatment using intravenous cholecystography. After stone clearance, the recurrence of gallstones was monitored by using ultrasonography. Cox regression analysis was used to determine the risk factors associated with stone recurrence. (ii) Gallbladder bile was sampled from 59 gallstone patients during surgery. Biliary cholesterol, phospholipids, and total bile acids were simultaneously quantified by using gas-liquid chromatography.


RESULTS
Impaired gallbladder function, but not gallstone recurrence, was more frequently observed in older patients (>/=65 years old) than in younger patients (<65 years old). Cox regression analysis revealed that poor gallbladder emptying was an independent predictor of stone recurrence after ESWL in the total study population, but not in the older patients (>/=65 years old). Analysis of bile from surgically treated patients with cholesterol stones showed a significantly higher total lipid concentration and a shorter nucleation time in the younger group (<65 years old), but the cholesterol saturation index did not differ between the younger and older groups.


CONCLUSIONS
Our data suggest that the reduced concentrating function of the gallbladder in elderly gallstone patients helps to counteract stone recurrence despite their abnormal gallbladder motility. Therefore, aged gallstone patients may be preferentially treated by a non-surgical strategy.
Tazuma
Susumu
S
First Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan. stazuma@hiroshima-u.ac.jp
Nishioka
Tomoji
T
Ochi
Hidenori
H
Hyogo
Hideyuki
H
Sunami
Yasushi
Y
Nakai
Kuniharu
K
Tsuboi
Kazuhiko
K
Asamoto
Yasumasa
Y
Sakomoto
Minoru
M
Numata
Yoshihiro
Y
Kanno
Keishi
K
Yamaguchi
Atsushi
A
Kobuke
Toshiya
T
Komichi
Daisuke
D
Nonaka
Yoshihiro
Y
Chayama
Kazuaki
K
D000367:Age Factors; D000368:Aged; D001646:Bile / Q000378:metabolism; D002769:Cholelithiasis / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005704:Gallbladder / Q000503:physiopathology*; D016473:Gallbladder Emptying / Q000502:physiology*; D006801:Humans; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012044:Regression Analysis; D012306:Risk; D055502:Secondary Prevention