Unconjugated bilirubin in human bile: the nucleating factor in cholesterol cholelithiasis?
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.
Dutt
M K
MK
Gastrointestinal Laboratory, The Rayne Institute, St Thomas's Hospital, London SE1 7EH, UK.
Murphy
G M
GM
Thompson
R P H
RP
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
D001647:Bile Acids and Salts; D010743:Phospholipids; D002784:Cholesterol; D001663:Bilirubin