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Volume 41 Issue 9
Sep.  2025
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Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(9): 1868-1876

Influence of juxtapapillary duodenal diverticula on bile microecology in patients with primary common bile duct stones

DOI: 10.12449/JCH250923
  • 1.

    Graduate School of Hebei North University，Zhangjiakou，Hebei 075000，China

  • 2.

    Department of Gastroenterology，Hebei General Hospital，Shijiazhuang 050051，China

  • 3.

    Graduate School of Hebei Medical University，Shijiazhuang 050017，China

Research funding:

The 2023 Hebei Provincial Government Funded Medical Talent Project (ZF2023188)

More Information
  • Corresponding author: HOU Hongtao， llvzi@126.com （ORCID： 0000-0003-1339-3205）
  • Received Date: 2025-03-11
  • Accepted Date: 2025-05-06
  • Published Date: 2025-09-25
    Abstract
  •   Objective  To investigate the microbiological characteristics of bile in patients with common bile duct stones alone or comorbid with juxtapapillary duodenal diverticula （JPDD）.  Methods  A prospective study was conducted among 30 patients with common bile duct stones who were admitted to Department of Gastroenterology， Hebei General Hospital， from January to May 2024， and according to the presence or absence of JPDD， they were divided into JPDD group and simple common bile duct stones group （CBD group）， with 15 patients in each group. Bile samples were collected during endoscopic retrograde cholangiopancreatography， and 16S rRNA microbial sequencing was performed to compare the differences in microbial composition， diversity， and metabolic pathways between the two groups. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. Pearson correlation analysis or Spearman correlation analysis was used to analyze the correlation between clinical indicators and microbial species abundance.  Results  Clinical data showed that compared with the CBD group， the JPDD group had significantly greater maximum diameter of stones （10.87±3.42 mm vs 6.80±2.08 mm， t=3.94， P<0.01） and common bile duct diameter （14.73±3.95 mm vs 9.67±2.64 mm， t=4.13， P<0.01）. The microbiological analysis of the bile showed that Proteobacteria， Bacteroidetes， Firmicutes， and Actinobacteria were the most common phyla in both groups， and Proteobacteria was the dominate phylum in the JPDD group. At the genus and species levels， the JPDD group had higher relative abundances of Escherichia-Shigella， Enterococcus， and Escherichia coli. Alpha diversity was similar between the two groups， and there was a significant difference in beta diversity between the two groups （Adonis test， P<0.05）. The LEfSe analysis identified 25 differentially expressed species （LDA>2） between the two groups， and the JPDD group had enrichment of 7 flora such as Enterobacter， Enterococcaceae， and Klebsiella， while the CBD group had significant enrichment of 18 flora such as Peptococcaceae， Roseburia， and Alistipes （P<0.05）. The correlation analysis showed that Enterococcaceae and Enterococcus significantly enriched in the JPDD group were positively correlated with the diameter of the common bile duct and the maximum diameter of stones （P<0.01）， whereas Peptococcaceae， Acinetobacter， and Alistipes with reductions in expression were negatively correlated with the diameter of the common bile duct and the maximum diameter of stones （P<0.05）. The enrichment analysis of biliary microbial metabolic pathways showed that there were significant differences between the two groups in 10 metabolic pathways such as cell growth and death， transportation and decomposition， nervous system， biosynthesis of valine， leucine， and isoleucine， and histidine metabolism （P<0.05）.  Conclusion  The presence of JPDD may lead to alterations in bile microbiota， such as an increase in Enterococcus and a reduction in Roseburia， and specific flora and metabolism can promote the formation of common bile duct stones.

     

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