Association between gallstone-evoked pain, inflammation and proliferation of nerves in the gallbladder: a possible explanation for clinical differences.
OBJECTIVE
To investigate whether enhanced neuroproliferation could be involved in the pathogenesis of gallstone pain.


METHODS
Gallbladders from 117 patients with gallstones and 43 controls were examined. The gallbladder samples were immunostained against the pan-neuronal marker PGP 9.5 and the number of nerves and nerve area per tissue area estimated.


RESULTS
More nerves and an increased nerve area per tissue area were found in uncomplicated symptomatic gallstone disease. In comparison, acute cholecystitis displayed a significantly (p=0.01) decreased number of nerves and nerve area per tissue area. In both categories, the gallbladder neck contained more nerves (p=0.06 and 0.04, respectively) and an increased nerve area per tissue area (p=0.034 and 0.008, respectively) than the body.


CONCLUSIONS
Uncomplicated disease showed enhanced neuroproliferation, significantly more in the gallbladder neck, whereas significantly fewer nerves were observed in acute cholecystitis. Nerve growth alteration may play a role in uncomplicated gallstone pain but the pathology may be different in inflammation.
Hennig
Rene
R
Departments of Surgery, University of Heidelberg, Heidelberg, Germany. rene.hennig@med.uni-heidelberg.de
Zanli
Jiang
J
Osman
Tarek
T
Esposito
Irene
I
Berhane
Tewelde
T
Vetrhus
Morten
M
Søndenaa
Karl
K
Büchler
Markus W
MW
Friess
Helmut
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005704:Gallbladder / Q000294:innervation* / Q000473:pathology; D042882:Gallstones / Q000150:complications* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009417:Nerve Tissue / Q000254:growth & development* / Q000473:pathology; D010146:Pain / Q000209:etiology*; D043222:Ubiquitin Thiolesterase / Q000276:immunology
C482860:UCHL1 protein, human; D043222:Ubiquitin Thiolesterase