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Prolonged Orocecal Transit Time Enhances Serum Bile Acids Through Bacterial Overgrowth, Contributing Factor to Gallstone Disease

Kaur, Jaspreet MS*; Rana, Satya V. PhD*; Gupta, Rajesh Mch; Gupta, Vikas Mch; Sharma, Surendra K. MS*; Dhawan, Devinder K. PhD

Journal of Clinical Gastroenterology: April 2014 - Volume 48 - Issue 4 - p 365–369
doi: 10.1097/MCG.0b013e3182a14fba

Background: Gallstones (GS) are associated with slow intestinal transit but the effect of altered transit time on physiological changes in gastrointestinal tract among GS patients is poorly understood.

Goals: To investigate the association of gallstone disease with change in intestinal motility and how motility alters serum bile acid (SBA) levels.

Study: A total of 333 subjects were enrolled, of which 183 were GS patients and 150 age-matched and sex-matched controls. Intestinal transit time was assessed by measuring orocecal transit time (OCTT). Breath tests were used to evaluate OCTT and small intestinal bacterial overgrowth (SIBO). Total SBA levels were measured by enzymatic colorimetric assay. A linear regression analysis was performed to look for interrelationship between OCTT and SBA levels.

Results: Orocecal transit time was significantly delayed (P<0.001) in GS patients (134.8±30.64 min) compared with controls (85.35±19.81 min). SIBO was observed to be significantly higher (P<0.01) in patients (15%) compared with controls (0.7%). OCTT was further delayed significantly (P<0.01) in GS patients with SIBO (165.6±33.9 min) compared with patients lacking SIBO. Total SBA levels were found to be significantly higher (P<0.05) in GS patients (5.3±2.7 μmol/L) compared with controls (3.7±1.8 μmol/L). SBA levels were also significantly higher (P<0.05) in SIBO-positive GS patients (6.4±2.8 μmol/L) compared with SIBO-negative patients (4.8±2.4 μmol/L). There was positive correlation between OCTT and SBA levels in SIBO-positive patients.

Conclusions: The findings indicate that delayed OCTT leads to SIBO and thus enhance SBA levels in etiology underlying GSs.

*Department of Super Specialty of Gastroenterology

General Surgery, Postgraduate Institute of Medical Education & Research

Biophysics, Panjab University, Chandigarh, India

Supported by the Indian Council of Medical Research, New Delhi, India. There were no study sponsors. The work was independent.

The authors declare that they have nothing to disclose.

Reprints: Satya V. Rana, PhD, Department of Super Specialty of Gastroenterology, Postgraduate Institute of Medical Education & Research, House Number 137, Sector-15A, Chandigarh 160015, India (e-mail:

Received February 26, 2013

Accepted June 18, 2013

© 2014 by Lippincott Williams & Wilkins