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The Link Between Estrogen and Gallbladder Disease

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... or obstruction of the gallbladder or its duct ... Before treatment, gallbladder disease affected a quarter of the patients equally ... Gallbladder Disease. ... – PowerPoint PPT presentation

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Title: The Link Between Estrogen and Gallbladder Disease


1
The Link Between Estrogen and Gallbladder Disease
  • Kelly Butler
  • Advisor Dr. Grimes
  • April 18, 2008

2
The Gallbladder
  • Storage and concentrating unit for bile
  • Contracts to release bile in response to food,
    especially fatty foods
  • Dysfunction occurring to slow or obstruct the
    flow of bile from the gallbladder results in
    gallbladder disease

3
Epidemiology
  • Common around the world
  • Higher rates of gallstone formation in western
    Caucasian, Hispanic, and Native American
    populations
  • Lower rates in eastern European countries,
    African Americans, and Japanese
  • Eastern Kentucky, there is an abnormally high
    incidence of gallbladder disease with gallstone
    formation.
  • Female gt male

4
Pathophysiology
  • Includes inflammation, infection, stones, sludge,
    or obstruction of the gallbladder or its duct
  • Cholesterol gallstone formation is thought to
    rely on three factors, which include (1)
    supersaturation of biliary cholesterol from liver
    oversecretion, (2) nucleation of cholesterol
    monohydrate crystals, and (3) gallbladder
    hypomotility

5
Estrogen
  • Primary female sex hormones
  • Regulating the development of secondary sex
    characteristics
  • Regulate the menstrual cycle
  • Stimulate the uterine lining to thicken

6
Estrogen Receptors
  • The liver, which produces bile, has estrogen
    receptors present. Endogenous estrogens act on
    these receptors to cause cholesterol saturation
    in the bile. Exogenous estrogens have been shown
    to affect physiologic markers in a pattern that
    favors gallstone formation. Progestins, which
    are often given in combination with estrogen for
    therapy, inhibit gallbladder contraction which
    increases bile stasis and can decrease the
    gallbladders response to cholecystokinin

7
Pregnancy Induced
  • Alterations in cholesterol metabolism and
    decreased gallbladder motility
  • Increasing pregnancies increased risk of
    developing gallstones
  • Ireland study
  • Usually asymptomatic after delivery
  • Levels of estrogen return to normal cycling after
    delivery

8
Oral Contraceptives
  • Accelerate the development of cholesterol
    gallstones in women who are already susceptible
    because cholesterol saturation is higher in
    persons using oral contraceptives as compared to
    nonusers
  • Medical University in Bangladesh

9
Post-menopausal Women and HRT
  • Womens Health Initiative
  • Estrogen alone (with hysterectomy) or EP group
    (without hystectomy)
  • Risk for gallstones or cholecystectomy is
    increased by a factor of 2-3 in postmenopausal
    women receiving estrogen
  • Causal relationship between estrogen therapy and
    gallstones and risk of surgical procedure among
    women using estrogen alone or a combination of
    estrogen and progestin

10
Prostate Carcinoma
  • Study in Sweden looked at the development of
    gallstones in men with prostate cancer who
    received estrogen therapy vs. orchidectomy
  • Before treatment, gallbladder disease affected a
    quarter of the patients equally distributed
    between the groups
  • Five patients previously without gallstones
    before treatment in the estrogen group developed
    new gallstones
  • Four patients in the estrogen group with previous
    gallstones had an increase in the number or size
    of gallstones and increasing symptomatic pain
  • Biliary lipids analysis showed an increase in the
    concentration of cholesterol and cholesterol
    saturation of bile during estrogen treatment

11
Male-to-Female Transsexuals
  • One known health risk seen is that estrogen can
    cause male-to-female transsexual patients to be
    at a higher risk for gallbladder disease
  • Hospital in Germany, over 800 patients, elevated
    liver enzymes and symptomatic gallstones

12
Conclusions
  • OCs should be used with caution in those women
    who have a pre-existing or predisposition to
    gallbladder disease
  • Further Research Womens International Study of
    Long Duration Estrogen after Menopause in 14
    countries, results expected in 2012
  • The risks for males is shown to be the same as in
    females
  • Estrogen is probably a contributing factor in the
    development of gallstones

13
References
  • Scragg, R.K.R., A.J. McMichael, and R.F.
    Searmark. 1984. Oral Contraceptives, Pregnancy,
    and Endogenous Oestrogen in Gall Stone Disease -
    A Case Control Study. British Medical Joural.
    Vol. 288, p. 1795-1800
  • Richardson, J. David, F.Douglas Scutchfield,
    Warren H. Proudfoot, and Abram S. Benenson.
    1973. Epidemiology of Gallbladder Disease in an
    Appalachian Community Comparisons with the
    Framingham and Pima Indian Studies. Health
    Services Reports. Vol. 88, No. 3.
  • Oriel, Kathleen A. 2000. Medical Care of
    Transsexual Patients Clinical Update. Journal
    of the Gay and Lesbian Medical Association. Vol.
    4, No. 4.
  • Medline Plus Medical Encyclopedia. Gallbladder
    Disease. http//www.nlm.nih.gov/medlineplus/print
    /ency/article/001138.htm Accessed November,
    2007.
  • McCollum, Basso L., M.R. Darling, A. Tocchi, and
    W.A. Tanner. 1992. A Study of Cholelithiasis
    During Pregnancy and Its Relationship with Age,
    Parity, Menarche, Breast-feeding, Dysmenorrhea,
    Oral Contraception, and a Maternal History of
    Cholelithiasis. Surgical Gynecology and
    Obstetrics. Vol. 175, No. 1 41-46.
  • Henriksson, Peter, Kurt Einarsson, Ambjörn
    Eriksson, Ulrike Kelter, and Bo Angelin. 1989.
    Estrogen-Induced Gallstone Formation in Males
    Relation to Changes in Serum and Biliary Lipids
    during Hormonal Treatment of Prostatic Carcinoma.
    Journal of Clinical Investigation. Vol. 84, p.
    811-816.
  • Everson, Gregory T., Carol McKinley, and Fred
    Kern, Jr. 1991. Mechanisms of Gallstone
    Formation in Women Effects of Exogenous
    Estrogen (Premarin) and Dietary Cholesterol on
    Hepatic Lipid Metabolism. Journal of Clinical
    Investigation. Vol. 87, p. 237-246.
  • Bateson, Malcolm C. 1999. Gallbladder Disease
    Fortnightly Review. British Medical Journal.
    Vol. 318 1745-1748.
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