title: Abnormal duodenal bile composition in patients with acalculous chronic cholecystitis.
abstract: OBJECTIVE
  Our goal was to characterize biliary lipid composition in patients with the syndrome of chronic biliary pain, absence of gallstones, and inflammation of the gallbladder mucosa (acalculous chronic cholecystitis).
  
  
  METHODS
  Duodenal bile, obtained from 27 patients with a history of right upper quadrant pain and with negative imaging studies of the biliary tract, was analyzed enzymatically for bile acids, phospholipids, and cholesterol. Fifteen patients were found to have inflammation and/or fibrosis of the gallbladder at cholecystectomy.
  
  
  RESULTS
  The 15 patients with abnormal gallbladder histology had more dilute duodenal bile, as indicated by a low bile acid concentration and a lower proportion of phospholipids (p < 0.01) when values were compared with those of duodenal bile samples from postmenopausal women without gallbladder disease or from radiolucent gallstone subjects participating in the National Cooperative Gallstone Study. Cholecystectomy relieved pain in 9 of 14 patients.
  
  
  CONCLUSIONS
  Some patients with acalculous chronic cholecystitis have duodenal bile samples characterized by a decreased bile acid concentration and a decreased proportion of biliary phospholipids. The low biliary bile acid concentration may result from impaired gallbladder contraction and/or secretion by the biliary tract epithelium. The low proportion of phospholipid may result from posthepatic hydrolysis of luminal phosphatidylcholine followed by absorption of the hydrolysis products. The latter process could be caused by and/or contribute to mucosal inflammation and would also elevate the cholesterol saturation of bile, increasing the risk for cholesterol gallstone formation.
authors.affiliation: Department of Medicine, University of California, San Diego 92103-0813, USA.
authors.forename: A
authors.initials: A
authors.lastname: Venkataramani
authors.forename: R M
authors.initials: RM
authors.lastname: Strong
authors.forename: D S
authors.initials: DS
authors.lastname: Anderson
authors.forename: I T
authors.initials: IT
authors.lastname: Gilmore
authors.forename: K
authors.initials: K
authors.lastname: Stokes
authors.forename: A F
authors.initials: AF
authors.lastname: Hofmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000737:chemistry*; D001647:Bile Acids and Salts / Q000032:analysis; D002764:Cholecystitis / Q000378:metabolism* / Q000601:surgery; D002784:Cholesterol / Q000032:analysis; D005260:Female; D005705:Gallbladder Diseases / Q000473:pathology; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D010743:Phospholipids / Q000032:analysis
chemical_list: D001647:Bile Acids and Salts; D010743:Phospholipids; D002784:Cholesterol