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Deoxycholic acid is not related to lithogenic factors in gallbladder bile
D Jüngst1, I Müller, G A Kullak-Ublick
1Department of Medicine II, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany.
Insights
Deoxycholic acid (DCA) percentage in gallbladder bile does not correlate with cholesterol gallstone formation factors. Elevated DCA levels appear to have minor significance in cholesterol gallstone development in patients with normal gallbladder function.
Area of Science:
- Gastroenterology
- Hepatobiliary Science
- Bile Acid Metabolism
Background:
- The role of deoxycholic acid (DCA) in cholesterol gallstone pathogenesis remains debated.
- Previous studies may have been confounded by patient selection and methodology.
Purpose of the Study:
- To investigate the relationship between DCA percentage and lithogenic factors in gallbladder bile.
- To clarify DCA's role in cholesterol gallstone formation in patients with normal or moderately impaired gallbladder contractility.
Main Methods:
- Analysis of gallbladder bile from patients with cholesterol gallstones and pigment stones (control).
- Quantification of DCA percentage and assessment of lithogenic factors including cholesterol saturation index (CSI).
- Correlation analysis between DCA percentage and various lithogenic parameters.
Main Results:
- DCA percentage in cholesterol gallstone patients was similar to pigment stone patients.
- No significant correlation was found between DCA percentage and CSI, protein, mucin, or cholesterol crystals.
- Lack of correlation persisted in native and ultracentrifuged bile samples.
Conclusions:
- In patients with normal or moderately impaired gallbladder function, the percentage of DCA in bile is not associated with key factors driving cholesterol gallstone formation.
- Elevated DCA levels in gallbladder bile likely play a minor role in the pathophysiology of cholesterol gallstones.
Abstract:
The influence of deoxycholic acid (DCA) on the factors in gallbladder bile responsible for cholesterol gallstone disease has been a controversial subject of discussion. This might be partially due to patient selection or inappropriate methods. Therefore, we investigated the relationship between the percentage of DCA and lithogenic factors in the gallbladder bile of patients with cholesterol gallstones and with normal or moderately impaired gallbladder contractility. Patients with pigment stones served as a control group. The percentage of DCA in the gallbladder bile of 20 patients with cholesterol stones (23.2%+/-6.5%; mean+/-SD) was comparable to the DCA percentage in the gallbladder bile of 11 patients with pigment stones (26.5%+/-8.5%). No correlation was seen between the DCA percentage of total bile acids and the crystal observation time, cholesterol saturation index (CSI), total protein value, mucin level, and amount of cholesterol in vesicles or crystals in the total group of patients or in the subgroups with cholesterol or pigment stones, respectively. The lack of correlation between DCA percentage and CSI was determined in native bile (r = 0.048) as well as in crystal-free bile after ultracentrifugation (r = 0.107). Our findings demonstrate that in patients with gallstones, the percentage of DCA in gallbladder bile is not related to any of the known biliary factors associated with cholesterol gallstone disease. We conclude that in patients with normal or moderately impaired gallbladder function, an elevated DCA level in the gallbladder bile is of minor pathophysiologic significance for the formation of cholesterol gallstones.