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Gallstone Disease

Pathophysiology and Therapeutic Approaches

  • Conference proceedings
  • © 1990

Overview

Editors:
  1. W. Swobodnik

    1. Abteilung Innere Medizin II, Gastroenterologie und Ernährungswissenschaften, Universitätsklinikum Ulm, Ulm, Germany

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  2. R. D. Soloway

    1. Division of Gastroenterology, University of Texas Medical Branch at Galveston, Galveston, USA

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  3. H. Ditschuneit

    1. Abteilung Innere Medizin II, Gastroenterologie und Ernährungswissenschaften, Universitätsklinikum Ulm, Ulm, Germany

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Table of contents (30 papers)

  1. Front Matter

    Pages I-XVI
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  2. Pathobiochemistry and Pathophysiology of Gallstone Development: Importance for Clinical Decision Processes

    1. Front Matter

      Pages 1-1
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    2. Increased Biliary Lithogenicity Through Cholesterol Supersaturation

      • M. C. Carey
      Pages 3-10

    3. Nucleation and Aggregation of Cholesterol Crystals in the Early Phase of Gallstone Genesis

      • G. Salvioli, R. Lugli, M. Pellati
      Pages 11-25

    4. Modulation of the Edge Tension of Lipid Membranes by Cholate and Cholesterol and the Micelle-Vesicle Transition in Model Bile Systems

      • P. Fromherz
      Pages 27-33

    5. Pigment Gallstones and Secondary Calcification of Gallstones

      • R. D. Soloway, J. G. Wu, D. F. Xu
      Pages 35-46

    6. The Influence of the Gallbladder Epithelium on Gallstone Formation

      • B. F. Smith
      Pages 47-53

    7. Biliary Proteins and Their Role as Nucleating Inhibitors/Promotors

      • P. R. C. Harvey, S. M. Strasberg
      Pages 55-66

    8. Neurohormonal Aspects of Gallbladder Contractility in Gallstone Disease: The Role of Cholecystokinin

      • U. G. Klueppelberg, X. Molero, H. Y. Gaisano, L. J. Miller
      Pages 67-86

    9. Environmental Factors and Gallstones

      • J. G. Wechsler
      Pages 87-92

  3. Different Therapeutic Approaches to Gallstone Disease

    1. Front Matter

      Pages 93-93
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    2. Is Therapeutic Intervention Necessary in Gallstone Disease: The Surgeon’s Point of View

      • B. S. Ashby
      Pages 95-98

    3. Surgical Therapy for Acute Gallstone Complications

      • W. Oettinger, K. Orth, B. Leibl
      Pages 99-101

    4. Therapeutic Interventions in Patients with Gallbladder Stones: The Internist’s View

      • G. Paumgartner
      Pages 103-107

    5. Acute Biliary Pancreatitis

      • P. Malfertheiner
      Pages 109-114

    6. Systemic Litholysis with Bile Acids

      1. Principles of Gallstone Dissolution with Chenodeoxycholic Acid, Ursodeoxycholic Acid, and the Combination of both Bile Acids
        • A. Stiehl
        Pages 115-120
      2. Systemic Litholysis with Bile Acids: Ursodeoxycholic Acid
        • W. Kurtz
        Pages 121-125
      3. Combination Therapy of Chenodeoxycholic Acid and Ursodeoxycholic Acid
        • M. Podda, M. Zuin, M. L. Petroni, E. Bertolini, A. Crosignani, G. Grandinetti
        Pages 127-133
      4. Results of an Index-Controlled Combination Therapy with Ursodeoxycholic and Chenodeoxycholic Acid
        • P. Janowitz, W. Swobodnik, J. G. Wechsler, S. Fischer, J. Tudyka, H. Ditschuneit
        Pages 135-145

    7. Extracorporeal Shock-Wave-Lithotripsy

      1. Physical Basis of Lithotriptors
        • U. Faust
        Pages 147-159
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Keywords

About this book

The nonsurgical management of gallstone disease has drawn widespread clinical interest during the last decade as ultrasound surveys have indicated that cholelithiasis is predom­ inantly an asymptomatic condition and much more prevalent than previously thought. This book presents an overview of the pathophysiologic and pathobiochemical principles of gallstone formation and the consequences for clinical therapeutic regimens. New information concerning the balance between vesicular and micellar transport of choles­ terol, early cholesterol nucleation, and the influence of inhibiting and promoting com­ pounds for cholesterol nucleation as well as information concerning the effects of changes in gallbladder motility and gallbladder mucosal function is reviewed. In order to make further progress in developing treatments which facilitate gallstone dissolution and in preventing disease, it is necessary to integrate this new data into our thinking. Methods of treatment such as systemic litholysis of cholesterol gallbladder stones with bile acid preparations and mechanical fragmentation of stones either by extracorpo­ ral shock waves or intracorporal laser systems are carefully described and separate discussions of direct contact litholysis of cholesterol stones with ether preparations and the local litholytic treatment of calcified pigment stones are included. New therapeutic applications of HMG-CoA-reductase inhibitors and nonsteroidal anti-inflammatory drugs are also critically reviewed. Finally, for the interested reader an evaluation of prophylactic treatment against stone recurrence after successful conservative treatment and an appraisal of alternative management strategies supplement the information on the conservative treatment of gallstones.

Editors and Affiliations

  • Abteilung Innere Medizin II, Gastroenterologie und Ernährungswissenschaften, Universitätsklinikum Ulm, Ulm, Germany

    W. Swobodnik, H. Ditschuneit

  • Division of Gastroenterology, University of Texas Medical Branch at Galveston, Galveston, USA

    R. D. Soloway

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