Banerjee Tuhina, Goswami Aakansha Giri, Basu Somprakas
Microbiology, Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh, Varanasi 221005, India.
Department of General Surgery, All India Institute of Medical Sciences, Uttarakhand, Rishikesh 249203, India.
World J Gastrointest Surg. 2024 Nov 27;16(11):3395-3399. doi: 10.4240/wjgs.v16.i11.3395.
With increasing evidence, the biliary tract and the gallbladder mucosa are no longer considered sterile environments devoid of bacteria. Rather a profound biofilm of resident bacterial flora is associated with the mucosal surface. The bile too harbors a resident flora. It is when a dysbiotic process ensues, that this bacterial flora either becomes opportunist or is replaced by a pathogenic one that has a strong ability to survive the challenges of the biliary environment. Although once believed a metabolic problem, recent evidence indicates a complex interaction between different species of bacteria and gallbladder mucosa and bile which may culminate in calculus formation. The resident microbiota and its several enzymes dictate the type of gallstone by the mere interplay of the constituting type of bacteria in the biofilm, even without any evidence of infection. Dysbiosis is often mediated by either intestinal dysbiosis or less probably by oral dysbiosis. The gallstones, in turn, provide a haven for the resident microbiota in which they can form their own defined niche enriched with the biofilm that can resist the biliary defense mechanisms and survive the hostile biliary environment in the background of biliary stasis and local infection. However, this process of silent friendship is more complex than said, and further research is needed to define the relationship between the two.
随着证据的增多，胆道和胆囊黏膜不再被视为没有细菌的无菌环境。相反，一层深厚的常驻细菌群落生物膜与黏膜表面相关联。胆汁中也存在常驻菌群。当发生生态失调过程时，这种细菌群落要么成为机会致病菌，要么被一种在胆道环境挑战下具有强大生存能力的致病菌所取代。尽管曾经认为这是一个代谢问题，但最近的证据表明，不同种类的细菌与胆囊黏膜和胆汁之间存在复杂的相互作用，这可能最终导致结石形成。常驻微生物群及其多种酶仅通过生物膜中构成细菌类型的相互作用就决定了胆结石的类型，甚至在没有任何感染迹象的情况下也是如此。生态失调通常由肠道生态失调介导，较少可能由口腔生态失调介导。反过来，胆结石为常驻微生物群提供了一个避难所，在其中它们可以形成自己特定的生态位，富含能够抵抗胆道防御机制并在胆汁淤积和局部感染背景下的恶劣胆道环境中生存的生物膜。然而，这种无声的共生过程比上述情况更为复杂，需要进一步研究来确定两者之间的关系。
