The role of microbiota in development of cholangiopathy in the practice of a family physician

This article discusses the role and place of microbiome shifts in the biliary tract in the pathogenesis of gallstone disease, with a focus on the role of bile salt hydrolases (BSH) from Clostridia and Bacteroides under normal conditions and during cholelithiasis. There is an increasing body of evidence suggesting that systemic imbalance between biliary and intestinal microbiota contributes to the development of inflammatory diseases of the gallbladder and biliary ducts more significantly than the direct impact of pathogenic microorganisms themselves. The text is structured into clinical sections: involvement of biliary tract microbiota in the pathogenesis of gallstone disease including the concept of microbiotic layer, clinical manifestations of dysbiosis (including possible biliary colic, cholelithiasis, cholecystitis, cholangitis, secondary irritable bowel syndrome), and diagnostics for these disorders such as laboratory markers (ALT/AST, CRP) and other diagnostic tests (ultrasound, probing, CT/MRI scans, quantitative PCR for Escherichia-Shigella/Clostridia). Issues regarding probiotic correction for prevention of cholelithiasis and cholangiopathies in this patient group are discussed.