Bile flow and biliary lipid secretion following release of biliary obstruction in man

In order to elucidate the relationship between bile acid secretion and the secretion of lecithin and cholesterol in the postcholestatic condition, five patients were studied after release of complete biliary obstruction. Ten patients operated on for uncomplicated gallstone disease served as controls. The secretion of bile acids, which constituted only newly synthesized acids, increased in the postcholestatic period 2.5-22 times. In spite of that the secretion rate of bile acids was low (less than or equal to 7.5 mumol x min-1). The pattern of the relationships between bile acid secretion and bile flow and bile acid secretion and lecithin and cholesterol secretion was the same in the postcholestatic patients as in the controls. However, the bile flow showed a higher bile acid dependency in the postcholestatic condition, and the bile-acid-independent flow varied considerably in these patients as compared with controls. Linear relations between the secretion rate of bile acids and lecithin and cholesterol secretion rates were found. Extrapolation to zero bile secretion revealed Y-intercepts, which were not statistically significantly different from origo. Calculations of bile acid - lecithin and bile acid - cholesterol relations in the controls at correspondingly low bile acid secretion rates (less than or equal to 5 mumol x min-1) gave results similar to those in the study group. The bile was supersaturated with cholesterol in all the postcholestatic patients similar to the condition in the controls at correspondingly low bile acid secretion rates. It is concluded that the bile acids are determinative for the biliary secretion of cholesterol and lecithin even at very low bile acid secretion rates. This conclusion was valid in patients with presumably normal liver function as well as in the early phase after release of severe cholestasis.