Gallbladder emptying in vivo, bile composition, and nucleation of cholesterol crystals in patients with cholesterol gallstones.
OBJECTIVE
Impaired postprandial gallbladder emptying may provide time for progressive bile concentration with formation of instable cholesterol-rich vesicles and fast nucleation of cholesterol crystals. The aim of this study was to assess postprandial gallbladder emptying, bile composition, and nucleation of cholesterol crystals in the same patient.


METHODS
In 30 patients with cholesterol gallstones, postprandial gallbladder emptying was measured ultrasonographically. In each patient, gallbladder bile composition (obtained at cholecystectomy) and nucleation of cholesterol crystals was determined. Patients were divided in 22 strong contractors (> 50% postprandial gallbladder emptying) and 8 weak contractors.


RESULTS
In weak contractors, bile salt and phospholipid concentrations were much higher than in strong contractors (234.6 +/- 24.7 vs. 130.3 +/- 10.8 mmol/L [P < 0.001] and 44.5 +/- 3.5 vs. 30.2 +/- 3.1 mmol/L [P < 0.05], respectively). Cholesterol concentrations were comparable in strong and weak contractors. Consequently, total lipid concentration was significantly higher (15.5 +/- 1.4 and 9.2 +/- 0.7 g/dL; P < 0.001) and cholesterol saturation index significantly lower (0.90 +/- 0.08 and 1.61 +/- 0.17; P < 0.001) in weak contractors. Nucleation time, percentage of cholesterol in vesicles, bile salt species, and molecular species of phosphatidylcholine were not significantly different.


CONCLUSIONS
Differences in bile composition can be linked to different patterns of postprandial gallbladder emptying and may point to two different pathways of gallstone formation.
Stolk
M F
MF
Department of Gastroenterology, University Hospital Utrecht, The Netherlands.
van Erpecum
K J
KJ
Renooij
W
W
Portincasa
P
P
van de Heijning
B J
BJ
vanBerge-Henegouwen
G P
GP
D000328:Adult; D001646:Bile / Q000737:chemistry*; D001647:Bile Acids and Salts / Q000032:analysis; D002769:Cholelithiasis / Q000503:physiopathology*; D002784:Cholesterol / Q000378:metabolism*; D003460:Crystallization; D005260:Female; D005704:Gallbladder / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010713:Phosphatidylcholines / Q000032:analysis
D001647:Bile Acids and Salts; D010713:Phosphatidylcholines; D002784:Cholesterol