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Awatif H. Issa*, Muthena M. Muthena and Adnan Al-Badran


The bacterial species found in the bile of patients with biliary disease (both gallstones and cholangitis) indicate that the intestinal flora is a main source of bacterobilia. Escherichia coli (E.coli), Streptococci or Enterococci, Enterobacter, Klebsiella, Pseudomonas, and Proteus are the species most frequently isolated from aerobic cultures. Clostridium andBacteroides species are often found in anaerobic isolates. In about half or more of the isolates from bile, a mixed infection is found. (Tabata& Nakayama, 1981; Vitettaet al., 1989).Propionibacterium species were isolated from bile in low frequency (Brismaret al., 1986). Actinomycetes species have been cultured from the center of human gallstones (Rainset al., 1960). Recently, there has been a great deal of interest in a possible connection between the gastric pathogen Helicobacter pylori and gallstones (Farshadet al., 2004; Maurer et al., 2006; Silvaet al., 2003). Interestingly, growth of this organism is inhibited by bile salts both in vivo and in vitro, and chemotactic assays show that bile salts actually repel the organism (Maurer et al., 2006). Findings that contradict the ability of H. pylori to colonize a healthy gallbladder,nonetheless, a number of groups claimed to have identified H. pylori DNA in biliary tissue and gallstones, however there are several problems with these studies that some samples were collected at endoscopic retrograde cholangiopancreatography(Silvaet al., 2003).Because H. pylori colonizes the gastric mucosa of more than half the world's population, the statistical chances for sample contamination by gastric H. pylori are high, Additionally, 16S ribosomal RNA genus-specific primers are commonly used to identify these organisms in polymerase chain reaction (PCR) analysis, despite the fact that these primer sets can amplify other non–H. pylorihelicobacters(Maurer et al., 2006).

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