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Altered bile composition during cholesterol gallstone formation: cause or effect?

T H Magnuson¹, K D Lillemoe, D E Scheeres

¹Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

The Journal of Surgical Research

|June 1, 1990

Summary

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Elevated gallbladder bile protein and cholesterol saturation precede gallstone formation. Other factors like calcium and bilirubin changes occur only after crystals form, suggesting protein is key in early cholesterol precipitation.

Area of Science:

Gastroenterology
Biliary Physiology
Biochemistry

Background:

Gallbladder stasis, absorption, and altered bile composition are suspected factors in cholesterol gallstone formation.
Previous research analyzed bile composition only after crystal or gallstone formation.

Purpose of the Study:

To test the hypothesis that changes in bile composition are a late effect, occurring after crystal formation.
To identify early indicators of cholesterol crystal precipitation in bile.

Main Methods:

Adult male prairie dogs were fed a control or cholesterol-rich diet for 5, 9, or 14 days.
Gallbladder bile was analyzed for crystals, ionized calcium, bilirubin, pH, total protein, and lipids.
Gallbladder stasis and cholesterol saturation index were calculated.

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Main Results:

Increased gallbladder bile cholesterol saturation and total protein concentration preceded cholesterol monohydrate crystal precipitation.
Changes in gallbladder ionized calcium, bilirubin, pH, stasis, and absorption were observed only after crystal and gallstone formation.
Elevated biliary protein was noted prior to nucleation, suggesting a role in cholesterol precipitation.

Conclusions:

Alterations in gallbladder bile calcium, bilirubin, pH, stasis, and absorption are not early changes in gallstone formation.
Increased biliary protein concentration precedes crystal nucleation and may mediate cholesterol precipitation in saturated bile.