Detection of Helicobacter pylori by PCR in the Bile with Bile Duct Stones or Cholangiocarcinoma

Roe, Im Hawn; Lee, Myung In; Jin, Yeoung Joo; Lim, Chang Young; Song, Il Han; Kim, Jung Won; Kim, Jung Taik; Yang, Mi Ra; Lee, Jong Hwa; Shin, Ji Hyun

Abstract

BACKGROUND AND AIMS: In Korea, the number of patients with hepatolithiasis and choledocho]ithiasis are much higher than those in western countries. Infection might play a major role in the pathogenesis of bile duct stones. Until now E.coli, Klebsiella sp.and Gram negative enteric organisms were considered as predominant organisms isolated from bile with bile duct stones. The prevalence of H. pylori infection in gastroduodenal disease is remarkable in Korea. Bile acid, at physiologic concentrations, is known to cause a growth inhibition in H. pylori in vitro. Tbe in vivo inhibitory effect of the bile acids on K. pylori, however, is unclear Therefore, we investigated if H. pylori might be associated with bile duct stones or cholangiocarcinoma.
METHODS
Fifty two bile samples of 47 cases of bile duct stones (18 of IHD stone, 22 of CBD stone, 7 of IHD and CBD stone) and 5 cases of cholangiocarcinoma proven by histology were evaluated. 32 bile samples were collected by endoscopic nasobiliary drainage tube and 12 by percutanous transhepatic bile duct drainage tube. These 44 bile samples were collected on 5 to 7 days after ERCP without endoscopic shincterotomy. 8 samples were obtained by needle aspiration of gallbladder during laparoscopic cholecystectomy. 26 kDa surface antigen of H. pylori was detected using polymerase chain reaction (PCR) amplification.
RESULTS
7 of 52 cases (13,5%) were positive for H. pylori 26 kDa surface antigen. Of the 7 cases, 6 cases were bile duct stone (2 of IHD stone, 3 of IHD and CBD stone, 1 of CBD and GB stone) and 1 case was hilar cholan-giocarcinoma. Among 7 cases of 26 kDa surface antigen positive, 4 cases of H. pylori DNA was detected in the bile from PTBD (including one case of needle aspiration of GB), and 3 cases in the bile from ENBD tube.
CONCLUSIONS
Therefore, we concluded that H.pylori could be detected in the biliary tree with hepatolithiasis, choledocholithiasis or cholangiocarcinoma in Korea. Further investigation will be required if H.pylori or its subtype could cause cholangitis.