BACTERIOLOGICAL STUDIES OF BILE FROM THE GALLBLADDER IN PATIENTS WITHCARCINOMA OF THE GALLBLADDER, CHOLELITHIASIS, COMMON BILE-DUCT STONESAND NO GALLSTONES DISEASE

Objective: To compare the presence of bacteria of bile from the gallbl adder in control subjects, patients with gallstones, and patients with carcinoma of the gallbladder. Design: Prospective open study Setting: University department of surgery Subjects: 372 patients of wham 36 ha d no signs of gallbladder disease; 211 underwent cholecystectomy for e ither symptomatic gallstone disease (n = 165) or acute cholecystitis ( n = 46); 67 had common bile duct stones and 58 were operated on for ca rcinoma of the gallbladder. Interventions: Aspiration of bile from the gallbladder. Main outcome measures: Prevalence of pathogenic bacteria in bile from the gallbladder and correlations between the presence of bacteria, the presence of cancer, and age. Results: No pathogenic bac teria were grown from the bile of the patients who had no signs of gal lstones disease. Among the 165 with symptomatic gallstone disease 52 ( 32%) had pathogens in their bile, and among the 46 with acute cholecys titis the corresponding figure was 19 (41%) while among patients with common bile duct stones this figure was 39 (58%). Among the 58 patient s with carcinoma of the gallbladder the bile grew organism in 47 (81%) . Patients over the age of 60 years tended to be more likely to have o rganism in their bile than patients aged 60 or less, and the differenc e was significant for symptomatic gallstone disease (p < 0.003). Signi ficant differences were also found between patients with symptomatic g allstone disease and those with carcinoma of the gallbladder in both a ge groups (p < 0.002 in each case). Most of the organism were aerobic or anaerobic Gram negative species, irrespective of type of disease or age. Conclusion: Bacteria may have a role in the development of carci noma of the gallbladder.