Bile Composition in Healthy and Gallstones Patients

Study Overview
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Brief Summary
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Determine differences between lithogenic and non-lithogenic bile composition.

Detailed Description
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Gallstones constitute an entity known from antiquity, which have been found even in Egyptian mummies. In elder Greece, Tralliano discovered that gallstones are formed in the liver. Vesalio and Falopio described gallstones inside de gallbladder after a human body dissection and in 1882 Langenbuch performed the first cholecystectomy with good results, becoming the gold standard technique for cholelithiasis. Nowadays, this pathology represents a public health problem in developed countries due to its high prevalence, which is getting higher, estimated between a 10 and a 15% of the population. However, gallstones are asymptomatic in the 80% of the cases. In 5 years, a 10-20% of these patients will become symptomatic. The global risk of generating symptoms is about a 2% per year, meanwhile biliary tract complications in asymptomatic patients represent a 0'3% per year. There are two main types of gallstones. The most common of them (70%) are cholesterol stones, composed of >50% of cholesterol. The other 30% are black pigment stones, with less than 20% of cholesterol in their composition. The common ways on gallstone formation are: cholesterol supersaturation (due to a liver oversecretion); defects on gallbladder absorption, secretion and motility mechanisms; and higher percentage of deoxycholic acid in the biliary acids due to a slower intestinal movement. All of that leads to supersaturation and cholesterol nucleation. Black pigment stones are formed of calcium bilirrubinate. The formation mechanism is not clearly defined, but there is an increment in not conjugated bilirubin levels, which is less soluble in water. These gallstones are more frequent in patients who show higher levels of this bilirubin, such as those with hemolysis, Gilbert syndrome or hereditary spherocytosis. They are also common in patients with Crohn disease (specially in those with ileal resection) and cystic fibrosis, in which exists an enterohepatic circulation alteration, driving to an increase on biliary salts and non-conjugated bilirubin levels. Our work hypothesis is that bile composition in patients with gallstones on the gallbladder is different from those who doesn't show lithiasis.

Official Title
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Gallbladder Bile Composition in Patients With Gallstones and Healthy Patients

Conditions
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Cholelithiasis, Gall Stone, Gall Bladder Disease

Intervention / Treatment
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* Diagnostic Test: Bile test
* Diagnostic Test: Blood test
* Diagnostic Test: Gall stone study
* Diagnostic Test: Microbiological bile test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for the Study Group: Patients included for an elective cholecystectomy. Normal hepatic and renal function. Able to understand the nature of the study. Wish to participate in the study and sign the informed consent. Inclusion Criteria for the Control Group: Patients included for an hepatectomy with gallbladder exeresis for surgery reasons, without lithiasis. Patients included for peritoneal carcinomatosis surgery with gallbladder exeresis for surgery reasons, without lithiasis. Organ donors. Normal hepatic and renal function. Able to understand the nature of the study. Wish to participate in the study and sign the informed consent. Exclusion Criteria: Under 16 years old Hepatic or renal insufficiency Impossibility to understand the aim of the study

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Lithogenic bile in symptomatic patient<br>Patients who are performed a cholecystectomy as a treatment of their gallbladder disease | Diagnostic Test: Bile test<br>* Analyze bile components related to gall stones synthesis (cholesterol, bile acids, phospholypids, etc.)<br>Diagnostic Test: Blood test<br>* Analyze blood components related to gall stones synthesis (cholesterol, bile acids, phospholypids, etc.)<br>Diagnostic Test: Gall stone study<br>* Study of the extracted gall stones, analyzing their composition, type, etc.<br>Diagnostic Test: Microbiological bile test<br>* Determination of the microbiological composition of the bile<br>|
| Lithogenic bile in asymptomatic patient<br>Patients who are performed a cholecystectomy for another reason (cancer, organ donation) and gall stones are found | Diagnostic Test: Bile test<br>* Analyze bile components related to gall stones synthesis (cholesterol, bile acids, phospholypids, etc.)<br>Diagnostic Test: Blood test<br>* Analyze blood components related to gall stones synthesis (cholesterol, bile acids, phospholypids, etc.)<br>Diagnostic Test: Gall stone study<br>* Study of the extracted gall stones, analyzing their composition, type, etc.<br>Diagnostic Test: Microbiological bile test<br>* Determination of the microbiological composition of the bile<br>|
| Non-lithogenic bile<br>Patients who are performed a cholecystectomy for another reason (cancer, organ donation) without gall stones | Diagnostic Test: Bile test<br>* Analyze bile components related to gall stones synthesis (cholesterol, bile acids, phospholypids, etc.)<br>Diagnostic Test: Blood test<br>* Analyze blood components related to gall stones synthesis (cholesterol, bile acids, phospholypids, etc.)<br>Diagnostic Test: Microbiological bile test<br>* Determination of the microbiological composition of the bile<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Differences of bile composition between cases and controls | Bilirrubine in mg/dL | Intra-operatively |