title: Unconjugated bilirubin in human bile: the nucleating factor in cholesterol cholelithiasis?
abstract: OBJECTIVE
  To investigate the concentrations of bilirubin, bilirubin conjugates, phospholipid, and cholesterol in the gall bladder bile obtained at surgery from patients with and without cholesterol gallstones.
  
  
  METHODS
  Gall bladder bile was collected during surgery, by puncture, from 20 patients with gallstones undergoing routine cholecystectomy and from eight patients with normal liver blood tests. Concentrations of bilirubin, bilirubin conjugates, phospholipid, and cholesterol were measured using standard procedures.
  
  
  RESULTS
  The proportion of total bilirubin that was unconjugated was significantly higher in the bile from patients with stones than in bile from control patients, whether or not the bile from either group was saturated with cholesterol or not. Indeed, the mean concentration of cholesterol was significantly higher in control bile samples.
  
  
  CONCLUSIONS
  The presence of stones was more closely related to the proportion of unconjugated bilirubin than to the degree of saturation of bile with cholesterol. Bilirubin and its metabolites probably play an important part in the formation of cholesterol gallstones.
authors.affiliation: Gastrointestinal Laboratory, The Rayne Institute, St Thomas's Hospital, London SE1 7EH, UK.
authors.forename: M K
authors.initials: MK
authors.lastname: Dutt
authors.forename: G M
authors.initials: GM
authors.lastname: Murphy
authors.forename: R P H
authors.initials: RP
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D001646:Bile / Q000737:chemistry* / Q000378:metabolism; D001647:Bile Acids and Salts / Q000032:analysis; D001663:Bilirubin / Q000032:analysis* / Q000378:metabolism; D016022:Case-Control Studies; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000378:metabolism* / Q000601:surgery; D002784:Cholesterol / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010743:Phospholipids / Q000032:analysis
chemical_list: D001647:Bile Acids and Salts; D010743:Phospholipids; D002784:Cholesterol; D001663:Bilirubin