Role of iron deficiency in the formation of gall stones

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Date: March-April 2006
From: Indian Journal of Surgery(Vol. 68, Issue 2)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 1,886 words
Lexile Measure: 1680L

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Byline: Muneesh. Kumar, B. Goyal, M. Mahajan, S. Singh

Background : The old axiom that a typical gall stone sufferer is a fat, fertile, female of fifty, is only partially true, as the disease is found in women soon after their first delivery and also in underweight and thin people. So while searching for other parameters, iron deficiency was found to be a new parameter of interest in the aetiology of gall stones. Aims : The study was aimed at establishing the role of iron deficiency in the supersaturation of bile with cholesterol and thus formation of gallstones. Setting and Design : 50 patients suffering from Cholelithiasis were divided into two groups. Group A consisted of patients with normal serum iron levels (non-anaemic) and group B, of patients with less than normal serum iron (anaemic). Serum cholesterol and gall bladder bile cholesterol of both the groups were studied and compared. Materials and Methods: 50 patients of Cholelithiasis, confirmed by Ultrasonography (USG) were divided into anaemic and non-anaemic groups, based on serum iron levels. Serum cholesterol and gall bladder bile cholesterol of both the groups were estimated. Statistical Analysis Used : Students' t-test. The p-value < 0.05 was considered significant. Results : Total serum cholesterol was not different in gall stone formers from that of the general population.Gall bladder bile cholesterol was significantly higher in anaemic, than in non-anaemic individuals. Conclusion : Low serum iron levels lead to bile supersaturation with respect to cholesterol, which leads to gallstone formation.

The old axiom, that a typical gall stone sufferer is a fat, fertile, female of fifty, is only partially true, as the disease has been found in women soon after their first delivery and also in underweight and thin people. So while searching the literature for different factors, Iron deficiency was found to be new and interesting aetiological factor in the formation of gall stones. Gallstones may produce symptoms, or may remain asymptomatic. Over half the cases are asymptomatic, usually detected by abdominal ultrasound. Today the incidence of gallstone disease has increased considerably with the invention of ultrasonography.[1] Three conditions must be met to permit the formation of cholesterol gallstones.

1. Bile must be supersaturated with cholesterol.

2. Nucleation must be kinetically favorable.

3. Cholesterol crystals must remain in the gall bladder long enough to agglomerate into stones.

Iron deficiency has been shown to alter the activity of several hepatic enzymes,[2] leading to increased gall bladder bile cholesterol saturation and promotion of cholesterol crystal formation.[3] Iron acts as a coenzyme for nitric oxide synthetase (NOS),[4] which synthesizes nitric oxide (NO)[5] and that is important for the maintenance of basal gall bladder tone and normal relaxation. It was found that iron deficiency resulted in altered motility of gall bladder and sphincter of Oddi (SO), leading to biliary stasis and thus increased cholesterol crystal formation in the gall...

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Gale Document Number: GALE|A145761558