Biliary bile acids in cholelithiasis and colon cancer

The role of biliary deoxycholate as an endogenous colon carcinogen and the possible association between cholelithiasis and/or cholecystectomy and the subsequent development of large bowel cancer is unclear. This paper describes biliary bile acids analysis performed on 13 patients undergoing cholecystectomy for gall stones, 10 patients undergoing colonic resection for colon cancer, and eight control patients. For all 31 patients the total bile acids concentration was highly variable (8.3 mg/ml-106.5 mg/ml). The median ratio of primary to secondary bile acids was 2.7:1. The biliary bile acid ratios were similar in both control patients (3.7:1) and those with colon cancer (3.1:1), whereas patients with gall stones had significantly higher secondary bile acid levels in their biliary bile (ratio 1.9:1, p = less than 0.05). This result indicates that raised biliary deoxycholate concentrations are not present in patients with colon cancer and are therefore unlikely to be a major predisposing factor in the aetiology of this disease. It is unlikely that cholelithiasis and/or cholecystectomy predispose to the subsequent development of colon tumours.