title: Impaired gallbladder mucosal function in aged gallstone patients suppresses gallstone recurrence after successful extracorporeal shockwave lithotripsy.
abstract: 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.
authors.affiliation: First Department of Internal Medicine, Hiroshima University School of Medicine, Hiroshima, Japan. stazuma@hiroshima-u.ac.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Tazuma
authors.forename: Tomoji
authors.initials: T
authors.lastname: Nishioka
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ochi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hyogo
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sunami
authors.forename: Kuniharu
authors.initials: K
authors.lastname: Nakai
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Asamoto
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakomoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Numata
authors.forename: Keishi
authors.initials: K
authors.lastname: Kanno
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kobuke
authors.forename: Daisuke
authors.initials: D
authors.lastname: Komichi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nonaka
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: 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