Gall bladder disease

Category: Illness or disabilities

Type

Involuntary

Introduction and description

The gallbladder (also gall bladder, biliary vesicle or cholecyst) is a small organ where bile (a fluid produced by the liver) is stored and concentrated before it is released into the small intestine.

Anatomically, the gallbladder is divided into three sections: the fundus, body, and neck: The fundus is a rounded end that faces the front of the body. The body is in contact with the liver, lying in the gallbladder fossa, a depression at the bottom of the liver. The neck tapers and is continuous with the cystic duct, part of the biliary tree.

There is little understanding of just how high the instance of disease is in the gall bladder, a much misunderstood organ.

In general, Gallbladder and biliary related diseases occurred in about 104 million people (1.6%) in 2013 and they resulted in 106,000 deaths. Women more commonly have stones than men and they occur more commonly after the age of 40.

Functions of the Gall bladder

Regulating the Intestinal flora and immune response

The intestinal flora not only processes our food, extracting nutrients, but is a key part of our immune system.  The management of the microbiota, the garden of bacteria and other organisms in our intestine is regulated by the gall bladder, which secretes bile

Food digestion

The gallbladder stores bile, also called gall, needed for the digestion of food. The liver produces the bile, which then flows through the hepatic ducts into the gallbladder. When food containing fat enters the digestive tract, it stimulates the secretion of cholecystokinin (CCK) from I cells of the duodenum and jejunum. In response to cholecystokinin, the gallbladder rhythmically contracts and releases its contents into the common bile duct, eventually draining into the duodenum. Bile contains bile salts, which solubilize fats in the digestive tract and aid in the intestinal absorption of fat molecules as well as the fat-soluble vitamins, A, D, E, and K.

The bile that is secreted by the liver and stored in the gallbladder is not the same as the bile that is secreted by the gallbladder. During gallbladder storage of bile, it is concentrated by removal of some water and electrolytes.

Storage for body repair and sexual activity material

Cholesterol, is an essential structural component of all animal cell membranes that is required to maintain both membrane structural integrity and fluidity. Cholesterol is not ‘bad’.  Within cells, cholesterol is a precursor molecule for the synthesis of vitamin D and all steroid hormones, including the adrenal gland hormones cortisol and aldosterone, as well as the sex hormones progesterone, estrogens, and testosterone, and their derivatives.  Without cholesterol you would be vitamin deprived, age very quickly and be entirely lacking in any sexual ability – impotent and infertile.

The liver excretes cholesterol into biliary fluids, which is then stored in the gallbladder.

It is then secreted by the gall bladder ‘in a non-esterified form’ (via bile) into the digestive tract. High cholesterol in your blood simply indicates a high level of damaged cells from some pathogen [or high sex drive!].

Cholesterol & phospholipids, are both electrical insulators, and improve the speed of transmission of electrical impulses along nerve tissue. For many neuron fibres, a myelin sheath, rich in cholesterol, provides insulation for more efficient conduction of impulses.  Lack of cholesterol is implicated in multiple sclerosis.

Bilirubin removal

Bile also acts as a means of eliminating bilirubin, a product of hemoglobin metabolism, from the body.

Types of gall bladder disease

• Cholecystitis is inflammation of the gallbladder. More than 90% of the time acute cholecystitis is from blockage of the bile duct by a gallstone.
• Gallbladder polyps (GBPs) – Gallbladder polyps are growths, or lesions resembling growths, that form in the gallbladder wall.  Polyps tend to be non malignant “the reported incidence of GBP malignancy is just 0.57%”  [PMID: 27465099], but they may impair function.
• Gallbladder (GB) perforation – can be a side effect of traumatic abdominal injury. It is potentially life-threatening. A punch in the stomach area for example may cause small defects which are difficult to detect.  “Colour Doppler US and contrast-enhanced US are the examinations of choice to detect the perforation site and show bile movement through the perforation” [PMID:  24151110]
• Gallbladder (GB) wall thickening  - is defined as a GB wall diameter >3.5 mm on abdominal ultrasound examination or computed tomography. It does not have one cause, but can be caused by many pathogens, for example in one study “Systemic infections were caused by bacteria in 10 patients (41.7%), viruses in 5 patients (20.8%), and fungi in 2 patients (8.3%).”[ PMID:  25061585].  By the time it is detected, the pathogen has often spread all over the body, and the person is often being treated for symptoms which are more obvious, for example “Systemic diseases observed included systemic lupus erythematosus in 2, congestive heart failure in 2, renal disorder in 2”. Hopefully this should bring home the pointlessness of symptom based medicine and organ speciality in medicine.  Pathogens get everywhere and the key is to identify the pathogens
• 

   
  Gallstones – are stones formed within the gallbladder out of bile components. The term cholelithiasis may refer to the presence of stones in the gallbladder or to the diseases caused by gallstones. Most people with gallstones (about 80%) never have symptoms.  Gallstones are typically formed from either cholesterol or bilirubin.  In the developed world, 10–15% of adults have gallstones. Rates in many parts of Africa, however, are as low as 3%.  “Brown pigment gallstones form spontaneously in infants who have bacterial infections in the biliary tract. PMID: 2642880”.  Gall stones are caused by gallbladder dysmotility.  In effect, the gall bladder is attacked by pathogens and gradually loses its function.  Initially biliary sludge is formed.  Biliary sludge refers to a viscous mixture of small particles derived from bile. These sediments consist of cholesterol crystals, calcium salts, calcium bilirubinate, mucin, and other materials.  Eventually these solidify to form stones.
• Ascending cholangitis - also known as acute cholangitis or simply cholangitis, is an infection of the bile duct (cholangitis), usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine). It tends to occur if the bile duct is already partially obstructed by gallstones.  Cholangitis can be life-threatening, and is regarded as a medical emergency. Characteristic symptoms include yellow discoloration of the skin or whites of the eyes, fever, abdominal pain, and in severe cases, low blood pressure and confusion - shock.
• Gall bladder cancer - Carcinoma of the gallbladder is the commonest malignancy of the biliary tract in northern India and the link to heavy metals as the cause has been repeatedly shown … “The present study demonstrated a significant decrease in serum, biliary, and tissue levels of selenium and zinc but increased copper, lead, cadmium, chromium, and nickel levels in patients with carcinoma of the gallbladder, indicating a strong relation between the concentrations of these metals and gallbladder cancer.”  [PMID: 23942528] But irritant particles in general can be a cause.
• Cholestasis is a condition where bile cannot flow from the liver to the duodenum. The two basic distinctions are an obstructive type of cholestasis where there is a mechanical blockage in the duct system that can occur from a gallstone or malignancy, and metabolic types of cholestasis which are disturbances in bile formation.  Drugs such as gold salts, nitrofurantoin, anabolic steroids, chlorpromazine, prochlorperazine, sulindac, cimetidine, erythromycin, estrogen, and statins can cause cholestasis and may result in damage to the liver.
• Porcelain gallbladder is a calcification of the gallbladder believed to be brought on by excessive gallstones, although the exact cause is not known.
• Strangulation of the gallbladder  - has rarely occurred.  The lesser omentum (small omentum or gastrohepatic omentum) is the double layer of peritoneum that extends from the liver to the lesser curvature of the stomach (hepatogastric ligament) and the first part of the duodenum (hepatoduodenal ligament).

Symptoms

Nausea and vomiting

Fever

Usually indicative of pathogens which the body is able to destroy using heat.

Pain

 Gall bladder problems can cause severe pain in the upper right part of the abdomen. In severe cases of infection, the pain feels like you are being stabbed, and it is possible to go into a state of shock. 

Jaundice

If a gall stone lodges in the biliary system, jaundice may occur; and if the stone blocks the pancreatic duct, then pancreatitis may occur.

Skin problems

– of various sorts, appearing like an allergic reaction.  Rashes, ulcer like spots, and itching may be present.  In the following example, the gall bladder disease is being caused by a parasite:

Psoriasis can be a comorbidity of gall bladder disease

Causes

Pharmaceuticals

One of the recurrent themes running through the following analyses is the fact that the patient was ‘immunocompromised’ at the time the infection occurred.  We are apt to associate immunocompromised people with AIDS, but let us now take you through a scenario which shows that a person can become immunocompromised by the ill-advised use of pharmaceuticals.

• Anti-histamines - The person gets a blocked nose.  The nose becomes blocked in order to protect the brain and the lungs from a pathogen.  The person uses anti-histamines, which are immunosuppressants and which serve to unblock the nose, but allow the pathogen to enter.
• Mouthwash - The person uses a mouthwash, which is anti-bacterial and thus destroys the friendly bacteria in the mouth which are a defense against pathogens entering the body.  Mouthwashes are thus immunosuppressants.  The pathogen enters the throat and from there may travel to the stomach or lungs.
• Antacids and PPIs - The person gets indigestion.  Not being able to digest food is due to forms of stress, the sympathetic nervous system acts to prevent digestion.  It may also be due to low stomach acid.  The person takes antacids, or Proton pump inhibitors which reduce the acid in the stomach even further.  The acid is a major defensive shield against many pathogens. Antacids and PPIs are thus  immunosuppressants.

• Antibiotics - A person goes to the emergency department of their hospital ill.  The first thing the medical staff may do is give them antibiotics, even when they have no idea of the cause of the illness.  Antibiotics destroy the intestinal flora, which are an absolutely key part of the immune system.  Antibiotics are thus immunosuppressants.
• Immunosuppressants - The person has one or more of a host of illnesses classified by the medical fraternity as auto-immune diseases.  None of these diseases are, but because the medical profession practises symptom based and not cause based medicine, they do not know the true cause of the illness.  In order to treat the symptoms but not the cause the doctor hands out immunosuppressants.
• Hormonal contraceptives - Whilst estrogens increase cholesterol secretion and diminish bile salt secretion, progestins act by reducing bile salt secretion and impairing gallbladder emptying. Cholesterol is used to repair the body as such progestins  are a form of immunosuppressant andheighten the risk of gallstone disease as many gallstones are formed from cholesterol.

The eHealthme site collect the Adverse drug reports submitted by doctors to the FDA and SEDA.  They have two categories for gall bladder disease worth exploring.  If you follow the links, and then scroll down for each symptom you will find a section entitled “Drugs causing xxx” by pressing this link you are provided with a list of all the pharmaceuticals that have caused gall bladder disease along with the number of cases:

• Gallbladder disorder – follow this LINK.  There are about 900 plus pharmaceuticals in this list that have caused gallbladder disorder

• Gallstones – follow this LINK.  There are about 1,550 plus pharmaceuticals in this list that have caused gallbladder disorder

Pharmaceuticals are a MAJOR cause of gall bladder disease.

Polysorbate 80 – Vaccines and Food additives

Polysorbate 80 is a nonionic surfactant and emulsifier often used in foods, medicines and cosmetics. This synthetic compound is a viscous, water-soluble yellow liquid.  Other names include - E number: E433; Brand names: Alkest TW 80, Scattics, Canarcel, Poegasorb 80, Tween 80 – Tween is a registered trademark of ICI Americas, Inc.

In foods - Polysorbate 80 is used as an emulsifier in foods.  For example, in ice cream, polysorbate is added up to 0.5% (v/v) concentration to make the ice cream smoother and easier to handle, as well as increasing its resistance to melting. Adding this substance prevents milk proteins from completely coating the fat droplets. This allows them to join together in chains and nets, which hold air in the mixture, and provide a firmer texture that holds its shape as the ice cream melts.

Vaccines and injected medicines - Polysorbate 80 is an excipient that is used to stabilize aqueous formulations of medications for parenteral administration. A parental administration may include:

• intravenous  - into a vein
• intra-arterial - into an artery
• intraosseous infusion - into the bone marrow
• intra-muscular

It is used as an excipient in some European and Canadian influenza vaccines, for example. Influenza vaccines contain 25 μg of polysorbate 80 per dose.

It is used as an emulsifier in the manufacture of the antiarrhythmic amiodarone.  It is used in the culture of Mycobacterium tuberculosis in Middlebrook 7H9 broth. It is also used as an emulsifier in the estrogen-regulating drug Estrasorb.

If the liver doesn’t work, neither will the gall bladder.

Viruses

A number of different viruses have been implicated in various forms of gall bladder disease.  The hepatitis family of viruses, all appear to be implicated:

And

The herpes family are also implicated:

Bacterial infection

This paper is a good summary of just how many bacteria could be implicated.  But, a warning note needs to be sounded here, as we have found in other sections that some bacteria are actually on our side, fighting viruses and pathogens:

And

And

Parasites

Gall bladder cysts, growths, tumours and cancers have been found to be associated with parasites, especially in the immunocompromised [see above, pharmaceuticals].  Some of the parasites that have been commonly associated with these disorders are Cryptosporidium species, Cystoisospora belli/Isospora belli, Cyclospora cayetanensis and Enterocytozoon bieneusi [common Name: Microsporidia].

Researchers have been able to make these findings, as so many people are now dying of AIDS and thus providing a ready source of organs for study.  But any immunocompromised person may suffer the same problems:

Coccidia can infect all mammals, some birds, some fish, some reptiles, and some amphibians. Most species of coccidia are species-specific in their choice of host. An exception is Toxoplasma gondii, which can infect all mammals, although it can only undergo sexual reproduction in cats.  Thus being with cats is a cause.  There are other parasites:

And

Toxins including heavy metals

Heavy metals are a well-known cause of gall bladder cancer and inflammation, but other toxins have also been implicated

Fungal infection

Treatment

 

 FIND THE CAUSE – TREAT THE CAUSE. 

The current medical approach

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP is now rarely performed without therapeutic intent.  It does not involve the removal of the gall bladder.
Stone recurrence is a common late adverse event after ERCP in patients with common bile duct stones (CBDS) [PMID:  25952091].  In other words, treating the symptoms gets you nowhere long term, one has to understand the cause to stop the problem recurring.

Lithotripsy is a medical procedure involving the physical destruction of hardened masses like kidney stones, or gallstones. The term is derived from the Greek words meaning "breaking (or pulverizing) stones.

Cholecystectomy - Where significant damage to the gall bladder exists, such that it has ceased to function, or it is severely cancerous, the standard procedure used by the medical profession is the Cholecystectomy.  Cholecystectomy is the surgical removal of the gallbladder.

It is, however, used almost as a standard procedure in some countries and hospitals for any problems of the gall bladder.  The cause of the problem is rarely investigated, as such a surgical procedure may be being used for something which is actually treatable.   Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older, more invasive procedure, called open cholecystectomy.

Given the absolutely key function of the gall bladder, one would have thought that this procedure was a treatment of truly last resort. 

Surgical removal of the gallbladder can lead to what is called “postcholecystectomy syndrome”.  Postcholecystectomy syndrome means you suffer from the following for the rest of your life

• Dyspepsia, nausea, and vomiting.
• Flatulence, bloating, and diarrhoea.
• Persistent pain in the upper right abdomen.

And cholecystectomy is a risk factor for nonalcoholic fatty liver disease  [PMID:  26566061]. 

These symptoms do not affect just a small number of people.  Depending on who is collecting the statistics, around 40 percent of patients who undergo cholecystectomy have them, and in 10% of the cases the symptoms are described as ‘chronic’.

“The pain associated with postcholecystectomy syndrome is usually ascribed to either sphincter of Oddi dysfunction or to post-surgical adhesions”.

Gall bladder disease is caused by something, as we have seen, and the problem of removing the gall bladder is that the pathogen is still there, so you just die of something else that it attacks, for example:

Why would a doctor recommend surgery this drastic with such appalling side effects, for an illness which may actually be treatable with plant based medicines or even less invasive surgery?  The answer, in some cases, appears to be money:

 

References and further reading

• Acta Parasitol. 2014 Jun;59(2):310-5. doi: 10.2478/s11686-014-0243-1. Epub 2014 May 15. First detection of acalculous cholecystitis associated with Sarcocystis infection in a patient with AIDS.  Agholi M1, Heidarian HR, Moghadami M, Hatam GR.
• Adv Clin Exp Med. 2015 Sep-Oct;24(5):829-36. doi: 10.17219/acem/27566.  Viral Hepatitis A in 108 Adult Patients During an Eight-Year Observation at a Single Center in Poland.  Bura M1, Michalak M2, Chojnicki MK3, Kowala-Piaskowska A1, Mozer-Lisewska I1.
• Allergol Immunopathol (Madr). 1994 Jul-Aug;22(4):155-60.  [Giardia lamblia extract (giardine): its immunologic mechanism].  [Article in Spanish]  Alvarez Guevara T1, Alfonso Fernández LA, Gómez Echevarría AH.
• Asian Pac J Cancer Prev. 2012;13(1):187-90. Chronic heavy metal exposure and gallbladder cancer risk in India, a comparative study with Japan. Chhabra D1, Oda K, Jagannath P, Utsunomiya H, Takekoshi S, Nimura Y.- 1Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India.
• Case Rep Pediatr. 2016;2016:9130673. doi: 10.1155/2016/9130673. Epub 2016 Apr 20.  Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection.  Gomes MM1, Antunes H2, Lobo AL3, Branca F4, Correia-Pinto J5, Moreira-Pinto J5.
• Clinics (Sao Paulo). 2009;64(12):1219-24. doi: 10.1590/S1807-59322009001200013.  The chronic gastrointestinal manifestations of Chagas disease.  Matsuda NM1, Miller SM, Evora PR.
• Eur J Clin Microbiol Infect Dis. 2016 Aug;35(8):1331-9. doi: 10.1007/s10096-016-2669-x. Epub 2016 May 18.  Association of diverse bacterial communities in human bile samples with biliary tract disorders: a survey using culture and polymerase chain reaction-denaturing gradient gel electrophoresis methods.  Tajeddin E1,2, Sherafat SJ1,2, Majidi MR2,3, Alebouyeh M4,5, Alizadeh AH2, Zali MR2.
• Eur J Gastroenterol Hepatol. 2016 Feb;28(2):181-6. doi: 10.1097/MEG.0000000000000512.  Relationship of hepatic fibrosis, cirrhosis, and mortality with cholecystectomy in patients with hepatitis C virus infection.  Martin DJ1, Weideman R, Crook T, Brown G.
• Adv Appl Microbiol. 2016;96:43-64. doi: 10.1016/bs.aambs.2016.07.019. Epub 2016 Aug 5.  In Sickness and in Health: The Relationships Between Bacteria and Bile in the Human Gut.  Hay AJ1, Zhu J1. - 1University of Pennsylvania, Philadelphia, PA, United States.
• Gastrointest Endosc. 2015 Oct;82(4):660-5. doi: 10.1016/j.gie.2015.03.1908. Epub 2015 May 5.  Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination.  Zhang R1, Luo H2, Pan Y2, Zhao L3, Dong J4, Liu Z2, Wang X2, Tao Q2, Lu G5, Guo X2.
• Infect Agent Cancer. 2016 Mar 3;11:12. doi: 10.1186/s13027-016-0057-x. eCollection 2016.  Non-typhoidal Salmonella DNA traces in gallbladder cancer.  Iyer P1, Barreto SG2, Sahoo B1, Chandrani P1, Ramadwar MR3, Shrikhande SV4, Dutt A1.
• Int J Surg. 2016 Jul 25;33(Pt A):28-35. doi: 10.1016/j.ijsu.2016.07.061. [Epub ahead of print]  The risk of malignancy in ultrasound detected gallbladder polyps: A systematic review.  Elmasry M1, Lindop D2, Dunne DF3, Malik H4, Poston GJ4, Fenwick SW4.
• J Am Coll Surg. 2016 Mar;222(3):303-8. doi: 10.1016/j.jamcollsurg.2015.12.016. Epub 2015 Dec 21.  Surgical Value of Elective Minimally Invasive Gallbladder Removal: A Cost Analysis of Traditional 4-Port vs Single-Incision and Robotically Assisted Cholecystectomy.  Newman RM1, Umer A2, Bozzuto BJ3, Dilungo JL3, Ellner S1.
• J Am Coll Surg. 2016 Mar;222(3):303-8. doi: 10.1016/j.jamcollsurg.2015.12.016. Epub 2015 Dec 21.  Surgical Value of Elective Minimally Invasive Gallbladder Removal: A Cost Analysis of Traditional 4-Port vs Single-Incision and Robotically Assisted Cholecystectomy.  Newman RM1, Umer A2, Bozzuto BJ3, Dilungo JL3, Ellner S1.
• J Antimicrob Chemother. 2014 Oct;69(10):2785-96. doi: 10.1093/jac/dku198. Epub 2014 Jun 20.  In vivo imaging of disseminated murine Candida albicans infection reveals unexpected host sites of fungal persistence during antifungal therapy.  Jacobsen ID1, Lüttich A2, Kurzai O3, Hube B4, Brock M5.
• J Clin Ultrasound. 2014 Jun;42(5):301-4. doi: 10.1002/jcu.22111. Epub 2013 Oct 22. A case of gallbladder perforation detected by sonography after a blunt abdominal trauma. Hongo M1, Ishida H, Naganuma H, Yoshioka H, Kasuya T, Niwa M.
• J Miss State Med Assoc. 2016 Jun;57(6):174-6.  Parasitic Infection of the Gallbladder: Cystoisospora belli Infection as a Cause of Chronic Abdominal Pain and Acalculous Cholecystitis.  Martelli MG, Lee JY.
• Nihon Shokakibyo Gakkai Zasshi. 2016;113(6):993-1000. doi: 10.11405/nisshoshi.113.993.  A case of abdominal tuberculosis lymphadenitis extending into the gallbladder and duodenum in a human T-cell lymphotropic virus type 1 carrier.  Mabuchi H1, Miyazato M, Maruwaka S, Kinjo Y, Nakachi N, Tomiyama R, Shimajiri H, Tomori H.
• Pediatr Gastroenterol Hepatol Nutr. 2014 Jun;17(2):98-103. doi: 10.5223/pghn.2014.17.2.98. Epub 2014 Jun 30.  Acalculous diffuse gallbladder wall thickening in children.  Lee JH1, No YE2, Lee YJ2, Hwang JY3, Lee JW3, Park JH2.
• PLoS One. 2015 Apr 8;10(4):e0121537. doi: 10.1371/journal.pone.0121537. eCollection 2015.  Chemical characterization of gallstones: an approach to explore the aetiopathogenesis of gallstone disease in Sri Lanka.  Weerakoon H1, Navaratne A2, Ranasinghe S3, Sivakanesan R3, Galketiya KB4, Rosairo S5.
• World J Surg. 2013 Nov;37(11):2641-6. doi: 10.1007/s00268-013-2164-9.  Heavy and trace metals in carcinoma of the gallbladder.  Basu S1, Singh MK, Singh TB, Bhartiya SK, Singh SP, Shukla VK.  1Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India, sombasu@hotmail.com.
• Vestn Ross Akad Med Nauk. 2016;(2):102-8.  [Hepatobiliary System Diseases as the Predictors of Psoriasis Progression].  [Article in Russian]  Smirnova SV, Barilo AA, Smolnikova MV.
• Trop Med Health. 2016 Jun 15;44:18. doi: 10.1186/s41182-016-0016-7. eCollection 2016.  Genotype 1 hepatitis E virus infection with acute acalculous cholecystitis as an extrahepatic symptom: a case report.  Fujioka K1, Nishimura T1, Seki M1, Kinoshita M1, Mishima N1, Irimajiri S1, Yamato M1.
• Surg Today. 2012 Jul;42(7):693-6. doi: 10.1007/s00595-012-0171-3. Epub 2012 Mar 31.  Floating gallbladder strangulation caused by the lesser omentum: report of a case.  Miyakura Y1, Sadatomo A, Ohta M, Lefor AT, Sata N, Nishimura N, Sakatani T, Yasuda Y.
• Surg Endosc. 2006 Sep;20(9):1364-7. Epub 2006 Jul 20.  Proton pump inhibitors reduce gallbladder function.  Cahan MA1, Balduf L, Colton K, Palacioz B, McCartney W, Farrell TM.  1Department of Surgery, University of North Carolina at Chapel Hill, Campus Box 7081, Chapel Hill, North Carolina 27599-7081, USA.
• SOJ Microbiol Infect Dis. 2016;4(1). doi: 10.15226/sojmid/4/1/00148. Epub 2016 Jun 1.  Food Additive P-80 Impacts Mouse Gut Microbiota Promoting Intestinal Inflammation, Obesity and Liver Dysfunction.  Singh RK1, Wheildon N2, Ishikawa S3.

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