Pigment gallstones

R. D. Soloway, B. W. Trotman, J. D. Ostrow

Research output: Contribution to journalArticle

167 Citations (Scopus)

Abstract

Pigment gallstones are defined as any dark brown to black stone, consisting of calcium salts of bilirubin, phosphate, carbonate and other anions; they can be separated into carbonate and noncarbonate containing groups. Pigment stones predominate in the rural Orient, in cirrhosis, and in elderly USA patients undergoing cholecystectomy. Clinical associations include bile duct obstruction, stasis, and possibly hemolysis. Of pigment stones, 50% are radioopaque and account for two thirds of all opaque stones. The concentrations of bile salts, phospholipids, cholesterol, and total bilirubin in bile are similar to normal levels, but the concentration of unconjugated bilirubin is increased in the bile of some patients. Increased unconjugated bilirubin in bile may be caused by increased hydrolysis of excreted conjugated bilirubin. Unconjugated bilirubin is solubilized by bile salts, but the interaction is primarily nonmicellar. Ionized calcium and pH are important determinants of solubility. Sulfated glycoproteins, excreted in increased amounts in patients with cholelithiasis, may be the site of pigment stone precipitation, because these compounds bind calcium salts tightly. E. coli is frequently cultured from pigment stones in Japan but not in the USA; thus, bacterial β glucuronidase may be important in stone formation in Japan but probably not in the West. Stasis leads to increased calcium secretion and to increases in the concentration of sparingly soluble compounds that may then precipitate. Incomplete emptying of the gallbladder may result in the same concentration process. Unsaturated fats and chronic vagal stimulation cause pigment stone formation in animals. At present, surgery is the only treatment for pigment lithiasis.

Original languageEnglish (US)
Pages (from-to)167-182
Number of pages16
JournalGastroenterology
Volume72
Issue number1
StatePublished - 1977
Externally publishedYes

Fingerprint

Gallstones
Bilirubin
Bile
Carbonates
Bile Acids and Salts
Japan
Calcium Compounds
Gallbladder Emptying
Unsaturated Fats
Calcium
Lithiasis
Cholelithiasis
Glucuronidase
Cholestasis
Cholecystectomy
Hemolysis
Solubility
Anions
Phospholipids
Glycoproteins

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Soloway, R. D., Trotman, B. W., & Ostrow, J. D. (1977). Pigment gallstones. Gastroenterology, 72(1), 167-182.

Pigment gallstones. / Soloway, R. D.; Trotman, B. W.; Ostrow, J. D.

In: Gastroenterology, Vol. 72, No. 1, 1977, p. 167-182.

Research output: Contribution to journalArticle

Soloway, RD, Trotman, BW & Ostrow, JD 1977, 'Pigment gallstones', Gastroenterology, vol. 72, no. 1, pp. 167-182.
Soloway RD, Trotman BW, Ostrow JD. Pigment gallstones. Gastroenterology. 1977;72(1):167-182.
Soloway, R. D. ; Trotman, B. W. ; Ostrow, J. D. / Pigment gallstones. In: Gastroenterology. 1977 ; Vol. 72, No. 1. pp. 167-182.
@article{1692d0f233234baeb76811e64af91fd8,
title = "Pigment gallstones",
abstract = "Pigment gallstones are defined as any dark brown to black stone, consisting of calcium salts of bilirubin, phosphate, carbonate and other anions; they can be separated into carbonate and noncarbonate containing groups. Pigment stones predominate in the rural Orient, in cirrhosis, and in elderly USA patients undergoing cholecystectomy. Clinical associations include bile duct obstruction, stasis, and possibly hemolysis. Of pigment stones, 50{\%} are radioopaque and account for two thirds of all opaque stones. The concentrations of bile salts, phospholipids, cholesterol, and total bilirubin in bile are similar to normal levels, but the concentration of unconjugated bilirubin is increased in the bile of some patients. Increased unconjugated bilirubin in bile may be caused by increased hydrolysis of excreted conjugated bilirubin. Unconjugated bilirubin is solubilized by bile salts, but the interaction is primarily nonmicellar. Ionized calcium and pH are important determinants of solubility. Sulfated glycoproteins, excreted in increased amounts in patients with cholelithiasis, may be the site of pigment stone precipitation, because these compounds bind calcium salts tightly. E. coli is frequently cultured from pigment stones in Japan but not in the USA; thus, bacterial β glucuronidase may be important in stone formation in Japan but probably not in the West. Stasis leads to increased calcium secretion and to increases in the concentration of sparingly soluble compounds that may then precipitate. Incomplete emptying of the gallbladder may result in the same concentration process. Unsaturated fats and chronic vagal stimulation cause pigment stone formation in animals. At present, surgery is the only treatment for pigment lithiasis.",
author = "Soloway, {R. D.} and Trotman, {B. W.} and Ostrow, {J. D.}",
year = "1977",
language = "English (US)",
volume = "72",
pages = "167--182",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Pigment gallstones

AU - Soloway, R. D.

AU - Trotman, B. W.

AU - Ostrow, J. D.

PY - 1977

Y1 - 1977

N2 - Pigment gallstones are defined as any dark brown to black stone, consisting of calcium salts of bilirubin, phosphate, carbonate and other anions; they can be separated into carbonate and noncarbonate containing groups. Pigment stones predominate in the rural Orient, in cirrhosis, and in elderly USA patients undergoing cholecystectomy. Clinical associations include bile duct obstruction, stasis, and possibly hemolysis. Of pigment stones, 50% are radioopaque and account for two thirds of all opaque stones. The concentrations of bile salts, phospholipids, cholesterol, and total bilirubin in bile are similar to normal levels, but the concentration of unconjugated bilirubin is increased in the bile of some patients. Increased unconjugated bilirubin in bile may be caused by increased hydrolysis of excreted conjugated bilirubin. Unconjugated bilirubin is solubilized by bile salts, but the interaction is primarily nonmicellar. Ionized calcium and pH are important determinants of solubility. Sulfated glycoproteins, excreted in increased amounts in patients with cholelithiasis, may be the site of pigment stone precipitation, because these compounds bind calcium salts tightly. E. coli is frequently cultured from pigment stones in Japan but not in the USA; thus, bacterial β glucuronidase may be important in stone formation in Japan but probably not in the West. Stasis leads to increased calcium secretion and to increases in the concentration of sparingly soluble compounds that may then precipitate. Incomplete emptying of the gallbladder may result in the same concentration process. Unsaturated fats and chronic vagal stimulation cause pigment stone formation in animals. At present, surgery is the only treatment for pigment lithiasis.

AB - Pigment gallstones are defined as any dark brown to black stone, consisting of calcium salts of bilirubin, phosphate, carbonate and other anions; they can be separated into carbonate and noncarbonate containing groups. Pigment stones predominate in the rural Orient, in cirrhosis, and in elderly USA patients undergoing cholecystectomy. Clinical associations include bile duct obstruction, stasis, and possibly hemolysis. Of pigment stones, 50% are radioopaque and account for two thirds of all opaque stones. The concentrations of bile salts, phospholipids, cholesterol, and total bilirubin in bile are similar to normal levels, but the concentration of unconjugated bilirubin is increased in the bile of some patients. Increased unconjugated bilirubin in bile may be caused by increased hydrolysis of excreted conjugated bilirubin. Unconjugated bilirubin is solubilized by bile salts, but the interaction is primarily nonmicellar. Ionized calcium and pH are important determinants of solubility. Sulfated glycoproteins, excreted in increased amounts in patients with cholelithiasis, may be the site of pigment stone precipitation, because these compounds bind calcium salts tightly. E. coli is frequently cultured from pigment stones in Japan but not in the USA; thus, bacterial β glucuronidase may be important in stone formation in Japan but probably not in the West. Stasis leads to increased calcium secretion and to increases in the concentration of sparingly soluble compounds that may then precipitate. Incomplete emptying of the gallbladder may result in the same concentration process. Unsaturated fats and chronic vagal stimulation cause pigment stone formation in animals. At present, surgery is the only treatment for pigment lithiasis.

UR - http://www.scopus.com/inward/record.url?scp=0017327056&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0017327056&partnerID=8YFLogxK

M3 - Article

VL - 72

SP - 167

EP - 182

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 1

ER -