CHOLELITHIASIS IN TAIWAN - GALLSTONE CHARACTERISTICS, SURGICAL INCIDENCE, BILE LIPID-COMPOSITION, AND ROLE OF BETA-GLUCURONIDASE

The nature and occurrence of gallstones in Taiwan and their etiologic factors might not be the same as in Western countries and warranted a systematic investigation. Gallbladder biles and gallstones were obtain ed at surgery from 100 and 74 patients, respectively. Common duct bile and stones were either drained through an indwelling common duct T-tu be or aspirated through a nasobiliary catheter in 108 patients. Gallst ones were analyzed for bilirubin, cholesterol, bile acid, calcium, and residue, and biles for bile acid, cholesterol, phospholipid, bilirubi n, and beta-glucuronidase. There were four major kinds of gallstones i n Taiwan: cholesterol/mixed stones, high-residue black formed pigment stones, low-residue brown formed pigment stones, and muddy pigment sto nes; The surgical incidence of all types of stones increased steadily during the past four decades. During the-past 15 years the relative fr equencies for mixed, formed pigment, and muddy pigment stones had been roughly 40, 40, and 20%, respectively, with a further increase in the mixed stones and a decrease in the muddy pigment stones in recent yea rs. Improvement of nutritional status and living standards might contr ibute to such changes. Cholesterol content in the common duct and gall bladder biles wa; higher in the mixed stone group than in other groups ; Bacterial beta-glucuronidase activity was detected in 53% of patient s with muddy pigment stones. Endogenous beta-glucuronidase activity an d concentration were also highest in this group, intermediate in the f ormed pigment and mixed stone group, and lowest in the control. We con cluded that hypercholesterobilia was responsible for increasing incide nce of mixed stones during the past two decades, while both bacterial and human beta-glucuronidase might contribute to pigment cholelithiasi s.