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ASPECTOS INTESTINALES DE LA FORMACION DE CALCULOS BILIARES DE COLESTEROL

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El intestino parece desempeñar un papel importante en el desarrollo de la litiasis vesicular por cálculos de colesterol debido a las interacciones complejas, integradas y sutiles con el sistema biliar.
portincasa9.jpg Autor:
Portincasa, piero
Columnista Experto de SIIC

Institución:
Clinica Medica "Augusto Murri" Department of Internal Medicine and Public Medicine (DIMIMP) University Medical School of Bari Bari, Italy

Artículos publicados por Portincasa, piero
Coautores
Karel J van Erpecum*  Marcin Krawczyk** 
MD, PhD. University of Utrecht Medical School, The Netherlands*
Medical student – Socrates Erasmus European mobility programmeUniversity of Lublin Medical School, Poland**
Recepción del artículo
3 de Mayo, 2004 		Aprobación
27 de Mayo, 2004
Primera edición
4 de Marzo, 2005 		Segunda edición, ampliada y corregida
7 de Junio, 2021

ASPECTOS INTESTINALES DE LA FORMACION DE CALCULOS BILIARES DE COLESTEROL

Resumen
La litiasis vesicular por cálculos de colesterol puede considerarse como una enfermedad que prevalece en el mundo occidental. La patogénesis es multifactorial e incluye la sobresaturación biliar de colesterol, la cristalización promovida por proteínas y el deterioro de la motilidad posprandial de la vesícula. Algunas investigaciones recientes indican que el intestino también desempeña un papel importante en la patogénesis de los cálculos de colesterol, si se consideran diversos factores. Una variedad de proteínas transportadoras está involucrada en el proceso de absorción intestinal de colesterol y podría vincularse con el incremento de su sobresaturación biliar. Más aun, el tránsito intestinal prolongado podría incrementar el riesgo de cálculos a través del aumento de la formación en el lumen intestinal de desoxicolato, una sal biliar hidrófoba secundaria y prolitogénica. Además, en personas normales existe relación estrecha entre la motilidad intestinal y la de la vesícula biliar en el período de ayuno (interdigestivo). Encontramos alteración en la motilidad intestinal, ausencia de contracción vesicular y liberación anormal de la hormona motilina en el período interdigestivo en pacientes con litiasis vesicular. Estos trastornos podrían contribuir a la formación de litos vesiculares y se discuten en el presente trabajo.

Palabras clave
Motilidad gastrointestinal, músculo liso, cristales de colesterol, motilidad de la vesícula biliar


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INTESTINAL ASPECTS OF CHOLESTEROL GALLSTONE FORMATION

Abstract
Cholesterol gallstone disease can be considered a mass disease in the Western world. Pathogenesis is multifactorial, including biliary cholesterol supersaturation, crystallization-promoting proteins and impaired postprandial gallbladder motility. Recent studies indicate that the intestine also plays an important role in pathogenesis of cholesterol gallstones, if one considers several factors. A number of transport proteins are involved in the process of intestinal cholesterol absorption and might provide links to increased biliary cholesterol supersaturation. Moreover, prolonged intestinal transit could increase gallstone risk by enhancing formation in the intestinal lumen of the secondary hydrophobic and pro-lithogenic bile salt deoxycholate. Furthermore, in normal subjects there is an intimate relationship between gallbladder and intestinal motility in the fasting (interdigestive) state. We found disordered intestinal motility, absent gallbladder contraction and abnormal release of the hormone motilin in the interdigestive state in gallstone patients. These disturbances could contribute to gallstone formation and are discussed in the present article.

Key words
Gastrointestinal motility, smooth muscle, cholesterol crystals, gallbladder motility


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Especialidades
Principal: Nefrología y Medio Interno
Relacionadas: Atención Primaria, Diagnóstico por Imágenes, Medicina Interna



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Bibliografía del artículo
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