Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis

Prospective comparative study

Cheal Wung Huh, Sung Ill Jang, Beom Jin Lim, Hee Wook Kim, Jae Keun Kim, Jun Sung Park, Ja Kyung Kim, Se Joon Lee, DongKi Lee

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Common bile duct (CBD) stones are generally associated with greater elevations of alkaline phosphatase and gamma-glutamyl transpeptidase levels than aspartate aminotransferase and alanine aminotransferase levels. However, some patients with CBD stones show markedly increased aminotransferase levels, sometimes leading to the misdiagnosis of liver disease. Therefore, the aim of this study was to investigate the clinicopathologic features of patients with CBD stones and high aminotransferase levels. This prospective cohort study included 882 patients diagnosed with CBD stones using endoscopic retrograde cholangiopancreatography (ERCP). Among these patients, 38 (4.3%) exhibited aminotransferase levels above 400IU/L without cholangitis (gallstone hepatitis [GSH] group), and 116 (13.2%) exhibited normal aminotransferase levels (control group). We compared groups in terms of clinical features, laboratory test results, radiologic images, and ERCP findings such as CBD diameter, CBD stone diameter and number, and periampullary diverticulum. Liver biopsy was performed for patients in the GSH group. GSH patients were younger and more likely to have gallbladder stones than control patients, implying a higher incidence of gallbladder stone migration. Also, GSH patients experienced more severe, short-lasting abdominal pain. ERCP showed narrower CBDs in GSH patients than in control patients. Histological analysis of liver tissue from GSH patients showed no abnormalities except for mild inflammation. Compared with control patients, GSH patients were younger and showed more severe, short-lasting abdominal pain, which could be due to a sudden increase of CBD pressure resulting from the migration of gallstones through narrower CBDs. These clinical features could be helpful not only for the differential diagnosis of liver disease but also for investigating the underlying mechanisms of liver damage in obstructive jaundice. Moreover, we propose a new definition of "gallstone hepatitis" based on the specific clinicopathologic characteristics observed in our patients.

Original languageEnglish
Article numbere5176
JournalMedicine (United States)
Volume95
Issue number42
DOIs
Publication statusPublished - 2016 Jan 1

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Choledocholithiasis
Cholangitis
Transaminases
Prospective Studies
Gallstones
Common Bile Duct
Hepatitis
Endoscopic Retrograde Cholangiopancreatography
Gallbladder
Abdominal Pain
Liver Diseases
Liver
Obstructive Jaundice
gamma-Glutamyltransferase
Diverticulum
Aspartate Aminotransferases
Diagnostic Errors
Alanine Transaminase

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Huh, Cheal Wung ; Jang, Sung Ill ; Lim, Beom Jin ; Kim, Hee Wook ; Kim, Jae Keun ; Park, Jun Sung ; Kim, Ja Kyung ; Lee, Se Joon ; Lee, DongKi. / Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis : Prospective comparative study. In: Medicine (United States). 2016 ; Vol. 95, No. 42.
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title = "Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis: Prospective comparative study",
abstract = "Common bile duct (CBD) stones are generally associated with greater elevations of alkaline phosphatase and gamma-glutamyl transpeptidase levels than aspartate aminotransferase and alanine aminotransferase levels. However, some patients with CBD stones show markedly increased aminotransferase levels, sometimes leading to the misdiagnosis of liver disease. Therefore, the aim of this study was to investigate the clinicopathologic features of patients with CBD stones and high aminotransferase levels. This prospective cohort study included 882 patients diagnosed with CBD stones using endoscopic retrograde cholangiopancreatography (ERCP). Among these patients, 38 (4.3{\%}) exhibited aminotransferase levels above 400IU/L without cholangitis (gallstone hepatitis [GSH] group), and 116 (13.2{\%}) exhibited normal aminotransferase levels (control group). We compared groups in terms of clinical features, laboratory test results, radiologic images, and ERCP findings such as CBD diameter, CBD stone diameter and number, and periampullary diverticulum. Liver biopsy was performed for patients in the GSH group. GSH patients were younger and more likely to have gallbladder stones than control patients, implying a higher incidence of gallbladder stone migration. Also, GSH patients experienced more severe, short-lasting abdominal pain. ERCP showed narrower CBDs in GSH patients than in control patients. Histological analysis of liver tissue from GSH patients showed no abnormalities except for mild inflammation. Compared with control patients, GSH patients were younger and showed more severe, short-lasting abdominal pain, which could be due to a sudden increase of CBD pressure resulting from the migration of gallstones through narrower CBDs. These clinical features could be helpful not only for the differential diagnosis of liver disease but also for investigating the underlying mechanisms of liver damage in obstructive jaundice. Moreover, we propose a new definition of {"}gallstone hepatitis{"} based on the specific clinicopathologic characteristics observed in our patients.",
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Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis : Prospective comparative study. / Huh, Cheal Wung; Jang, Sung Ill; Lim, Beom Jin; Kim, Hee Wook; Kim, Jae Keun; Park, Jun Sung; Kim, Ja Kyung; Lee, Se Joon; Lee, DongKi.

In: Medicine (United States), Vol. 95, No. 42, e5176, 01.01.2016.

Research output: Contribution to journalArticle

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T1 - Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis

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AU - Huh, Cheal Wung

AU - Jang, Sung Ill

AU - Lim, Beom Jin

AU - Kim, Hee Wook

AU - Kim, Jae Keun

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AU - Kim, Ja Kyung

AU - Lee, Se Joon

AU - Lee, DongKi

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AB - Common bile duct (CBD) stones are generally associated with greater elevations of alkaline phosphatase and gamma-glutamyl transpeptidase levels than aspartate aminotransferase and alanine aminotransferase levels. However, some patients with CBD stones show markedly increased aminotransferase levels, sometimes leading to the misdiagnosis of liver disease. Therefore, the aim of this study was to investigate the clinicopathologic features of patients with CBD stones and high aminotransferase levels. This prospective cohort study included 882 patients diagnosed with CBD stones using endoscopic retrograde cholangiopancreatography (ERCP). Among these patients, 38 (4.3%) exhibited aminotransferase levels above 400IU/L without cholangitis (gallstone hepatitis [GSH] group), and 116 (13.2%) exhibited normal aminotransferase levels (control group). We compared groups in terms of clinical features, laboratory test results, radiologic images, and ERCP findings such as CBD diameter, CBD stone diameter and number, and periampullary diverticulum. Liver biopsy was performed for patients in the GSH group. GSH patients were younger and more likely to have gallbladder stones than control patients, implying a higher incidence of gallbladder stone migration. Also, GSH patients experienced more severe, short-lasting abdominal pain. ERCP showed narrower CBDs in GSH patients than in control patients. Histological analysis of liver tissue from GSH patients showed no abnormalities except for mild inflammation. Compared with control patients, GSH patients were younger and showed more severe, short-lasting abdominal pain, which could be due to a sudden increase of CBD pressure resulting from the migration of gallstones through narrower CBDs. These clinical features could be helpful not only for the differential diagnosis of liver disease but also for investigating the underlying mechanisms of liver damage in obstructive jaundice. Moreover, we propose a new definition of "gallstone hepatitis" based on the specific clinicopathologic characteristics observed in our patients.

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