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Calcium and calcium binding in human gallstone disease
1Department of Surgery, Veterans Administration Lakeside Medical Center, Chicago, Ill.
Archives of Surgery (Chicago, Ill. : 1960)
|December 1, 1990
Summary
Bile from gallstone patients showed lower concentrations of sodium, bile salts, and phospholipids, but not higher calcium levels. However, over half of samples were supersaturated with calcium carbonate, suggesting a role for calcium precipitation in gallstone formation.
Area of Science:
- Gastroenterology
- Biliary tract physiology
- Gallstone pathogenesis
Background:
- Precipitation of calcium salts in bile is implicated in pigment gallstone formation.
- Calcium salts may act as a nidus for cholesterol precipitation, contributing to cholesterol gallstones.
Purpose of the Study:
- To compare gallbladder bile composition in patients with symptomatic gallstones versus non-biliary controls.
- To investigate the role of biliary calcium concentrations and calcium salt precipitation in gallstone disease.
Main Methods:
- Analysis of gallbladder bile from patients with cholesterol gallstones (n=40), pigment gallstones (n=12), and non-biliary controls (n=10).
- Measurement of bile concentration, sodium, bile salt, phospholipid, and calcium concentrations.
- Assessment of calcium binding and saturation levels for calcium salts, including calcium carbonate.
Main Results:
- Bile from gallstone patients was less concentrated, with reduced sodium, bile salt, and phospholipid levels compared to controls.
- No significant difference in elevated biliary calcium concentrations or calcium binding was observed between groups.
- Over 50% of all bile samples exhibited saturation or supersaturation with at least one calcium salt, particularly calcium carbonate.
Conclusions:
- While elevated biliary calcium levels were not definitively observed, the high prevalence of calcium salt supersaturation suggests calcium precipitation is a significant factor in gallstone pathogenesis.
- The findings support the importance of calcium carbonate precipitation in the development of gallstones, despite normal overall calcium concentrations in gallstone bile.