Thus, the aspects linking gallbladder removal with the metabolic syndrome deserve attention because of the high number of cholecystectomies being performed worldwide and affecting millions of patients. The metabolic syndrome represents a major public health problem with prevalence of about 25% of adults worldwide ) and is linked to increased risk of cardiovascular disease, type 2 diabetes, nonalcoholic fatty liver disease (NAFLD) and hepatocellular carcinoma, hyperuricemia and gout, cholesterol cholelithiasis. These processes, in turn, might lead to negative metabolic consequences, including the metabolic syndrome, currently defined by the International Diabetes Federation as the coexistence of central obesity (in Europids as a waist circumference ≥ 94 cm and 80 cm in male and female, respectively) plus any two of the following traits: triglycerides ≥150 mg/dL or treatment, high-density lipoprotein (HDL) cholesterol < 40 mg/dL in men or < 50 mg/dL in women or treatment,systo-diastolic blood pressure ≥ 130 and ≥ 85 mm/Hg, respectively, or treatment, fasting plasma glucose ≥100 mg/dL (5.6 mmol/L) or previously diagnosed type 2 diabetes. Also, the adjusted BA metabolism and recirculation might influence homeostatic pathways involving the BAs/farnesoid X receptor (FXR) and the BA/G protein-coupled BA receptor 1 (GPBAR-1, also named TGR5) axes in the liver, intestine, brown adipose tissue and muscle. The gallbladder removal can influence the enterohepatic circulation since the rhythmic functions of the gallbladder acting as a reservoir of bile and contractile pump are missing. Ĭholecystectomy, the most commonly performed surgical procedure worldwide, is performed laparoscopically in > 90% of the cases and represents the “gold standard” for surgical treatment of gallstones. According to this view, cholecystectomy, via BA-induced changes in the enterohepatic circulation, is a risk factor for the metabolic abnormalities and becomes another “fellow traveler” with, or another risk factor for the metabolic syndrome.Ĭholelithiasis encompasses a spectrum of conditions ranging from asymptomatic gallstones to uncomplicated symptomatic gallstone disease (biliary colic), to complicated gallstone disease (manifesting with acute cholecystitis, cholangitis, or gallstone pancreatitis). Alterations of intestinal microbiota leading to distorted homeostatic processes are also possible. Mechanisms are likely mediated by the abnormal transintestinal flow of BAs, producing metabolic signaling that acts without gallbladder rhythmic function and involves the BAs/farnesoid X receptor (FXR) and the BA/G protein-coupled BA receptor 1 (GPBAR-1) axes in the liver, intestine, brown adipose tissue and muscle. Cholecystectomy per se, however, might cause abnormal metabolic consequences, i.e., alterations in glucose, insulin (and insulin-resistance), lipid and lipoprotein levels, liver steatosis and the metabolic syndrome. Cholecystectomy is the most commonly performed surgical procedure worldwide in patients who develop symptoms and/or complications of cholelithiasis of any type. Bile acids (BAs), major lipid components of bile, play a key role as signaling molecules in modulating gene expression related to cholesterol, BA, glucose and energy metabolism. The gallbladder physiologically concentrates and stores bile during fasting and provides rhythmic bile secretion both during fasting and in the postprandial phase to solubilize dietary lipids and fat-soluble vitamins.
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