Ann Surg Treat Res.  2022 Mar;102(3):125-130. 10.4174/astr.2022.102.3.125.

Relationship between high bile juice amylase levels and chronic bacterial infections in patients with gallbladder cancer

Affiliations
  • 1Department of Surgery, Pusan National University School of Medicine, Busan, Korea
  • 2Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
  • 3Department of Radiology, Pusan National University School of Medicine, Busan, Korea
  • 4Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
  • 5Department of Pathology, Pusan National University School of Medicine, Busan, Korea
  • 6Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea

Abstract

Purpose
Pancreatic enzyme reflux into the biliary tract is associated with chronic inflammation and increased cellular proliferation in the biliary epithelium, leading to biliary carcinoma. We evaluated the relationship between high bile juice amylase levels and biliary microflora in patients with malignant gallbladder lesions.
Methods
In this retrospective study, 25 gallbladder specimens were obtained from patients with gallbladder cancer to evaluate amylase levels and perform bacterial culture. The samples were divided into high and low amylase groups and culture-positive and negative groups for analysis. Bile juice amylase 3 times higher than the normal serum amylase level (36–128 IU/L) was considered high.
Results
The number of positive cultures was higher in the high amylase group than in the low amylase group, but the difference was insignificant. There were no differences in other clinicopathological factors. Sixteen patients showed positive culture results; Escherichia coli and Klebsiella spp. were the most common gram-negative bacteria, whereas Enterococcus and Streptococcus spp. were the most common gram-positive bacteria. Age and bile juice amylase levels were significantly higher in the culture-positive group than in the culture-negative group. The incidence of bacterial resistance to cephalosporins was 6.25%–35.29%, and this incidence was particularly high for lower-generation cephalosporins.
Conclusion
Bacteria in gallbladder were identified more frequently when the amylase level was high. High amylase levels in the gallbladder can be associated with caused chronic bacterial infections with occult pancreaticobiliary reflux, potentially triggering gallbladder cancer

Keyword

Bacterial infections; Bile; Cholecystectomy; Gallbladder neoplasms; Reflux

Reference

1. Hanada K, Itoh M, Fujii K, Tsuchida A, Hirata M, Ishimaru S, et al. Pathology and cellular kinetics of gallbladder with an anomalous junction of the pancreaticobiliary duct. Am J Gastroenterol. 1996; 91:1007–1011. PMID: 8633539.
2. Schweizer P, Schweizer M. Pancreaticobiliary long common channel syndrome and congenital anomalous dilatation of the choledochal duct: study of 46 patients. Eur J Pediatr Surg. 1993; 3:15–21. PMID: 8466869.
Article
3. Imazu M, Iwai N, Tokiwa K, Shimotake T, Kimura O, Ono S. Factors of biliary carcinogenesis in choledochal cysts. Eur J Pediatr Surg. 2001; 11:24–27. PMID: 11370978.
Article
4. Yun SP, Lee JY, Jo HJ, Kim HS, Kim DH, Kim JH, et al. Long-term follow-up may be needed for pancreaticobiliary reflux in healthy adults. J Korean Surg Soc. 2013; 84:101–106. PMID: 23397015.
Article
5. Sharma V, Chauhan VS, Nath G, Kumar A, Shukla VK. Role of bile bacteria in gallbladder carcinoma. Hepatogastroenterology. 2007; 54:1622–1625. PMID: 18019679.
6. Goetze TO. Gallbladder carcinoma: prognostic factors and therapeutic options. World J Gastroenterol. 2015; 21:12211–12217. PMID: 26604631.
Article
7. Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol. 2014; 6:99–109. PMID: 24634588.
8. Espinoza JA, Bizama C, García P, Ferreccio C, Javle M, Miquel JF, et al. The inflammatory inception of gallbladder cancer. Biochim Biophys Acta. 2016; 1865:245–254. PMID: 26980625.
Article
9. Funabiki T, Matsubara T, Miyakawa S, Ishihara S. Pancreaticobiliary maljunction and carcinogenesis to biliary and pancreatic malignancy. Langenbecks Arch Surg. 2009; 394:159–169. PMID: 18500533.
Article
10. Tanno S, Obara T, Fujii T, Mizukami Y, Shudo R, Nishino N, et al. Proliferative potential and K-ras mutation in epithelial hyperplasia of the gallbladder in patients with anomalous pancreaticobiliary ductal union. Cancer. 1998; 83:267–275. PMID: 9669809.
Article
11. Sai JK, Suyama M, Kubokawa Y, Tadokoro H, Sato N, Maehara T, et al. Occult pancreatobiliary reflux in patients with a normal pancreaticobiliary junction. Gastrointest Endosc. 2003; 57:364–368. PMID: 12612517.
Article
12. Sai JK, Suyama M, Nobukawa B, Kubokawa Y, Sato N. Severe dysplasia of the gallbladder associated with occult pancreatobiliary reflux. J Gastroenterol. 2005; 40:756–760. PMID: 16082594.
Article
13. Vracko J, Markovic S, Wiechel KL. Conservative treatment versus endoscopic sphincterotomy in the initial management of acute cholecystitis in elderly patients at high surgical risk. Endoscopy. 2006; 38:773–778. PMID: 17001566.
Article
14. Sai JK, Suyama M, Nobukawa B, Kubokawa Y, Yokomizo K, Sato N. Precancerous mucosal changes in the gallbladder of patients with occult pancreatobiliary reflux. Gastrointest Endosc. 2005; 61:264–268. PMID: 15729237.
Article
15. Vracko J, Wiechel KL. Increased gallbladder trypsin in acute cholecystitis indicates functional disorder in the sphincter of oddi and could make EPT a logical procedure. Surg Laparosc Endosc Percutan Tech. 2003; 13:308–313. PMID: 14571164.
Article
16. Vracko J, Zemva Z, Pegan V, Wiechel KL. Sphincter of Oddi function studied by radioimmunoassay of biliary trypsin in patients with bile duct stones and in controls. Surg Endosc. 1994; 8:389–392. PMID: 8073354.
Article
17. Itokawa F, Itoi T, Nakamura K, Sofuni A, Kakimi K, Moriyasu F, et al. Assessment of occult pancreatobiliary ref lux in patients with pancreaticobiliary disease by ERCP. J Gastroenterol. 2004; 39:988–994. PMID: 15549453.
Article
18. Beltrán MA, Vracko J, Cumsille MA, Cruces KS, Almonacid J, Danilova T. Occult pancreaticobiliary reflux in gallbladder cancer and benign gallbladder diseases. J Surg Oncol. 2007; 96:26–31. PMID: 17345616.
Article
19. Matsuda T, Marugame T, Kamo K, Katanoda K, Ajiki W, Sobue T, et al. Cancer incidence and incidence rates in Japan in 2003: based on data from 13 population-based cancer registries in the Monitoring of Cancer Incidence in Japan (MCIJ) Project. Jpn J Clin Oncol. 2009; 39:850–858. PMID: 19797417.
Article
20. Kamisawa T, Kuruma S, Tabata T, Chiba K, Iwasaki S, Koizumi S, et al. Pancreaticobiliary maljunction and biliary cancer. J Gastroenterol. 2015; 50:273–279. PMID: 25404143.
Article
21. Sastry AV, Abbadessa B, Wayne MG, Steele JG, Cooperman AM. What is the incidence of biliary carcinoma in choledochal cysts, when do they develop, and how should it affect management? World J Surg. 2015; 39:487–492. PMID: 25322698.
Article
22. Matsuda M, Watanabe G, Hashimoto M, et al. Evaluation of pancreaticobiliary maljunction and low bile amylase. J Jpn Biliary Assoc. 2007; 21:119–124.
23. Darkahi B, Sandblom G, Liljeholm H, Videhult P, Melhus Å, Rasmussen IC. Biliary microflora in patients undergoing cholecystectomy. Surg Infect (Larchmt). 2014; 15:262–265. PMID: 24801654.
Article
Full Text Links
  • ASTR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr