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Review
. 2018 Mar;34(2):71-80.
doi: 10.1097/MOG.0000000000000423.

An update on the pathogenesis of cholesterol gallstone disease

Agostino Di Ciaula  1 , David Q-H Wang  2 , Piero Portincasa  3
Affiliations
Review

An update on the pathogenesis of cholesterol gallstone disease

Agostino Di Ciaula et al. Curr Opin Gastroenterol. 2018 Mar.

Abstract

Purpose of review: Gallstone disease is a major epidemiologic and economic burden worldwide, and the most frequent form is cholesterol gallstone disease.

Recent findings: Major pathogenetic factors for cholesterol gallstones include a genetic background, hepatic hypersecretion of cholesterol, and supersaturated bile which give life to precipitating cholesterol crystals that accumulate and grow in a sluggish gallbladder. Additional factors include mucin and inflammatory changes in the gallbladder, slow intestinal motility, increased intestinal absorption of cholesterol, and altered gut microbiota. Mechanisms of disease are linked with insulin resistance, obesity, the metabolic syndrome, and type 2 diabetes. The role of nuclear receptors, signaling pathways, gut microbiota, and epigenome are being actively investigated.

Summary: Ongoing research on cholesterol gallstone disease is intensively investigating several pathogenic mechanisms, associated metabolic disorders, new therapeutic approaches, and novel strategies for primary prevention, including lifestyles.

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Conflict of interest statement

Conflicts of interest

There are no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
(a) Solitary cholesterol gallstone showing a spheroidal modular surface. (b) Multiple cholesterol gallstones showing a multifaceted surface. Cholesterol content in both cases is more that 75%. (c) Pigment gallstones. Black, soft, friable, and easily pulverized material contains mainly calcium bilirubinate, calcium carbonate, and phosphate. A tiny amount of cholesterol (less than 10% cholesterol) can be found. The black horizontal lines at the bottom are equal to 1 cm.
FIGURE 2.
FIGURE 2.
Pathogenetic factors involved in the formation of cholesterol gallstones. Five primary defects are involved. The primary cause of cholesterol gallstone formation originates from increased hepatic hypersecretion of cholesterol. The genetic predisposition is largely involved in this process.
See this image and copyright information in PMC

References

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    2. The review deals with basic and clinical aspects of gallstone disease.

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