ABSTRACT
In the mid 1950s in Japan, the proportion of pigmented to cholesterol stones found in professionals was almost equal. However, almost 90% of the gallstones found in farmers were of pigmented calcium stone. As the farmers were economically less well off, they could only afford a diet which was deficient in fat and protein. It was postulated that the deficient diet may be a factor for the development of pigmented stone ( 13 ). Matsushiro et al. have demonstrated that a diet low in protein and fat leads to lower levels of glucaro-1:4-lactone, a powerful inhibitor of β -glucuronidase, in bile ( 14 ). The reduced level of glucaro-1:4-lactone in bile thus permits increased hydrolysis
introduction While practicing in Hong Kong in 1930, Digby drew attention to a condition which was subsequently known as recurrent pyogenic cholangitis by reporting on eight cases of “common duct stones of liver origin” ( 1 ). The term Recurrent Pyogenic Cholangitis (RPC) was used by Cook et al. in 1954 when they reported their experience with the condition in a series of 90 patients ( 2 ). The synonyms associated with this condition include Asiatic cholangiohepatitis, oriental cholangiohepatitis, Hong Kong Disease ( 3 ), Chinese biliary obstruction syndrome ( 4 ), and primary cholangitis ( 5 ). This condition is commonly seen in Chinese living in Canton and Hong Kong but is not restricted to the Chinese in the Orient since it also occurs in Chinese immigrants in Malaysia, Singapore, North America, and Australia ( 6-8 ). RPC is also common in Japanese in Japan and Taiwanese in Taiwan. Although rare, RPC has also been reported to afflict occidentals ( 9 , 10 ).
