Cholesterol cholelithiasis in pregnant women: Pathogenesis, prevention and treatment

Ornella de Bari, Tony Y. Wang, Min Liu, Chang Nyol Paik, Piero Portincasa, David Q.H. Wang

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Epidemiological and clinical studies have found that gallstone prevalence is twice as high in women as in men at all ages in every population studied. Hormonal changes occurring during pregnancy put women at higher risk. The incidence rates of biliary sludge (a precursor to gallstones) and gallstones are up to 30 and 12%, respectively, during pregnancy and postpartum, and 1-3% of pregnant women undergo cholecystectomy due to clinical symptoms or complications within the first year postpartum. Increased estrogen levels during pregnancy induce significant metabolic changes in the hepatobiliary system, including the formation of cholesterol-supersaturated bile and sluggish gallbladder motility, two factors enhancing cholelithogenesis. The therapeutic approaches are conservative during pregnancy because of the controversial frequency of biliary disorders. In the majority of pregnant women, biliary sludge and gallstones tend to dissolve spontaneously after parturition. In some situations, however, the conditions persist and require costly therapeutic interventions. When necessary, invasive procedures such as laparoscopic cholecystectomy are relatively well tolerated, preferably during the second trimester of pregnancy or postpartum. Although laparoscopic operation is recommended for its safety, the use of drugs such as ursodeoxycholic acid (UDCA) and the novel lipid-lowering compound, ezetimibe would also be considered. In this paper, we systematically review the incidence and natural history of pregnancy-related biliary sludge and gallstone formation and carefully discuss the molecular mechanisms underlying the lithogenic effect of estrogen on gallstone formation during pregnancy. We also summarize recent progress in the necessary strategies recommended for the prevention and the treatment of gallstones in pregnant women.

Original languageEnglish (US)
Pages (from-to)728-745
Number of pages18
JournalAnnals of Hepatology
Volume13
Issue number6
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Cholelithiasis
Gallstones
Pregnant Women
Cholesterol
Bile
Pregnancy
Postpartum Period
Therapeutics
Estrogens
Ursodeoxycholic Acid
Laparoscopic Cholecystectomy
Incidence
Second Pregnancy Trimester
Cholecystectomy
Gallbladder
Natural History
Epidemiologic Studies
Parturition
Lipids
Safety

Keywords

  • Bile acids
  • Biliary lipids
  • Biliary sludge
  • Estrogen
  • Ezetimibe
  • Gallstones
  • Progesterone

ASJC Scopus subject areas

  • Hepatology

Cite this

de Bari, O., Wang, T. Y., Liu, M., Paik, C. N., Portincasa, P., & Wang, D. Q. H. (2014). Cholesterol cholelithiasis in pregnant women: Pathogenesis, prevention and treatment. Annals of Hepatology, 13(6), 728-745.

Cholesterol cholelithiasis in pregnant women : Pathogenesis, prevention and treatment. / de Bari, Ornella; Wang, Tony Y.; Liu, Min; Paik, Chang Nyol; Portincasa, Piero; Wang, David Q.H.

In: Annals of Hepatology, Vol. 13, No. 6, 01.01.2014, p. 728-745.

Research output: Contribution to journalArticle

de Bari, O, Wang, TY, Liu, M, Paik, CN, Portincasa, P & Wang, DQH 2014, 'Cholesterol cholelithiasis in pregnant women: Pathogenesis, prevention and treatment', Annals of Hepatology, vol. 13, no. 6, pp. 728-745.
de Bari O, Wang TY, Liu M, Paik CN, Portincasa P, Wang DQH. Cholesterol cholelithiasis in pregnant women: Pathogenesis, prevention and treatment. Annals of Hepatology. 2014 Jan 1;13(6):728-745.
de Bari, Ornella ; Wang, Tony Y. ; Liu, Min ; Paik, Chang Nyol ; Portincasa, Piero ; Wang, David Q.H. / Cholesterol cholelithiasis in pregnant women : Pathogenesis, prevention and treatment. In: Annals of Hepatology. 2014 ; Vol. 13, No. 6. pp. 728-745.
@article{889d42f9732d4b15a7e75db411622a8d,
title = "Cholesterol cholelithiasis in pregnant women: Pathogenesis, prevention and treatment",
abstract = "Epidemiological and clinical studies have found that gallstone prevalence is twice as high in women as in men at all ages in every population studied. Hormonal changes occurring during pregnancy put women at higher risk. The incidence rates of biliary sludge (a precursor to gallstones) and gallstones are up to 30 and 12{\%}, respectively, during pregnancy and postpartum, and 1-3{\%} of pregnant women undergo cholecystectomy due to clinical symptoms or complications within the first year postpartum. Increased estrogen levels during pregnancy induce significant metabolic changes in the hepatobiliary system, including the formation of cholesterol-supersaturated bile and sluggish gallbladder motility, two factors enhancing cholelithogenesis. The therapeutic approaches are conservative during pregnancy because of the controversial frequency of biliary disorders. In the majority of pregnant women, biliary sludge and gallstones tend to dissolve spontaneously after parturition. In some situations, however, the conditions persist and require costly therapeutic interventions. When necessary, invasive procedures such as laparoscopic cholecystectomy are relatively well tolerated, preferably during the second trimester of pregnancy or postpartum. Although laparoscopic operation is recommended for its safety, the use of drugs such as ursodeoxycholic acid (UDCA) and the novel lipid-lowering compound, ezetimibe would also be considered. In this paper, we systematically review the incidence and natural history of pregnancy-related biliary sludge and gallstone formation and carefully discuss the molecular mechanisms underlying the lithogenic effect of estrogen on gallstone formation during pregnancy. We also summarize recent progress in the necessary strategies recommended for the prevention and the treatment of gallstones in pregnant women.",
keywords = "Bile acids, Biliary lipids, Biliary sludge, Estrogen, Ezetimibe, Gallstones, Progesterone",
author = "{de Bari}, Ornella and Wang, {Tony Y.} and Min Liu and Paik, {Chang Nyol} and Piero Portincasa and Wang, {David Q.H.}",
year = "2014",
month = "1",
day = "1",
language = "English (US)",
volume = "13",
pages = "728--745",
journal = "Annals of Hepatology",
issn = "1665-2681",
publisher = "Mexican Association of Hepatology",
number = "6",

}

TY - JOUR

T1 - Cholesterol cholelithiasis in pregnant women

T2 - Pathogenesis, prevention and treatment

AU - de Bari, Ornella

AU - Wang, Tony Y.

AU - Liu, Min

AU - Paik, Chang Nyol

AU - Portincasa, Piero

AU - Wang, David Q.H.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Epidemiological and clinical studies have found that gallstone prevalence is twice as high in women as in men at all ages in every population studied. Hormonal changes occurring during pregnancy put women at higher risk. The incidence rates of biliary sludge (a precursor to gallstones) and gallstones are up to 30 and 12%, respectively, during pregnancy and postpartum, and 1-3% of pregnant women undergo cholecystectomy due to clinical symptoms or complications within the first year postpartum. Increased estrogen levels during pregnancy induce significant metabolic changes in the hepatobiliary system, including the formation of cholesterol-supersaturated bile and sluggish gallbladder motility, two factors enhancing cholelithogenesis. The therapeutic approaches are conservative during pregnancy because of the controversial frequency of biliary disorders. In the majority of pregnant women, biliary sludge and gallstones tend to dissolve spontaneously after parturition. In some situations, however, the conditions persist and require costly therapeutic interventions. When necessary, invasive procedures such as laparoscopic cholecystectomy are relatively well tolerated, preferably during the second trimester of pregnancy or postpartum. Although laparoscopic operation is recommended for its safety, the use of drugs such as ursodeoxycholic acid (UDCA) and the novel lipid-lowering compound, ezetimibe would also be considered. In this paper, we systematically review the incidence and natural history of pregnancy-related biliary sludge and gallstone formation and carefully discuss the molecular mechanisms underlying the lithogenic effect of estrogen on gallstone formation during pregnancy. We also summarize recent progress in the necessary strategies recommended for the prevention and the treatment of gallstones in pregnant women.

AB - Epidemiological and clinical studies have found that gallstone prevalence is twice as high in women as in men at all ages in every population studied. Hormonal changes occurring during pregnancy put women at higher risk. The incidence rates of biliary sludge (a precursor to gallstones) and gallstones are up to 30 and 12%, respectively, during pregnancy and postpartum, and 1-3% of pregnant women undergo cholecystectomy due to clinical symptoms or complications within the first year postpartum. Increased estrogen levels during pregnancy induce significant metabolic changes in the hepatobiliary system, including the formation of cholesterol-supersaturated bile and sluggish gallbladder motility, two factors enhancing cholelithogenesis. The therapeutic approaches are conservative during pregnancy because of the controversial frequency of biliary disorders. In the majority of pregnant women, biliary sludge and gallstones tend to dissolve spontaneously after parturition. In some situations, however, the conditions persist and require costly therapeutic interventions. When necessary, invasive procedures such as laparoscopic cholecystectomy are relatively well tolerated, preferably during the second trimester of pregnancy or postpartum. Although laparoscopic operation is recommended for its safety, the use of drugs such as ursodeoxycholic acid (UDCA) and the novel lipid-lowering compound, ezetimibe would also be considered. In this paper, we systematically review the incidence and natural history of pregnancy-related biliary sludge and gallstone formation and carefully discuss the molecular mechanisms underlying the lithogenic effect of estrogen on gallstone formation during pregnancy. We also summarize recent progress in the necessary strategies recommended for the prevention and the treatment of gallstones in pregnant women.

KW - Bile acids

KW - Biliary lipids

KW - Biliary sludge

KW - Estrogen

KW - Ezetimibe

KW - Gallstones

KW - Progesterone

UR - http://www.scopus.com/inward/record.url?scp=84908667645&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908667645&partnerID=8YFLogxK

M3 - Article

C2 - 25332259

AN - SCOPUS:84908667645

VL - 13

SP - 728

EP - 745

JO - Annals of Hepatology

JF - Annals of Hepatology

SN - 1665-2681

IS - 6

ER -