title: Changes in gallbladder bile composition and crystal detection time in morbidly obese subjects after bariatric surgery.
abstract: The aim of the present study was to elucidate the mechanisms of development of cholesterol crystals and gallstones during weight reduction in obese subjects. Twenty-five morbidly obese, gallstone-free subjects underwent vertical-banded gastroplasty. Gallbladder bile was collected at the time of the operation via needle aspiration and 1.1-7.3 months after the operation via ultrasound-guided transhepatic puncture of the gallbladder. The mean weight loss was 17 kg. Two patients developed gallstones and 10 patients displayed cholesterol crystals in their bile. In patients with a follow-up time of less than 2 months (n = 13), cholesterol saturation increased from 90% to 114% but tended to decrease in the patients with a follow-up time of more than 2 months. The extraction of the concanavalin-A-binding fraction from gallbladder bile obtained after weight reduction in 7 patients prolonged crystallization detection time from 6 to 10 days. The hexosamine concentration, a marker for mucin, was increased by about 100% in bile obtained in 6 of 7 patients after weight reduction. In conclusion, the results indicate that crystallization-promoting compounds (mucin) are of great importance in the development of cholesterol crystals and gallstones in obese subjects during weight reduction, probably because of defective gallbladder emptying.
authors.affiliation: Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. ulf.gustafsson@ds.se
authors.forename: Ulf
authors.initials: U
authors.lastname: Gustafsson
authors.forename: Lisbet
authors.initials: L
authors.lastname: Benthin
authors.forename: Lars
authors.initials: L
authors.lastname: Granström
authors.forename: Albert K
authors.initials: AK
authors.lastname: Groen
authors.forename: Staffan
authors.initials: S
authors.lastname: Sahlin
authors.forename: Curt
authors.initials: C
authors.lastname: Einarsson
mesh_terms: D000328:Adult; D049088:Bariatrics / Q000379:methods; D001646:Bile / Q000737:chemistry* / Q000378:metabolism*; D001647:Bile Acids and Salts / Q000378:metabolism; D002784:Cholesterol / Q000378:metabolism; D003460:Crystallization; D005260:Female; D005704:Gallbladder / Q000378:metabolism*; D042882:Gallstones / Q000175:diagnosis* / Q000209:etiology; D015391:Gastroplasty; D006801:Humans; D050356:Lipid Metabolism; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000378:metabolism; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D009994:Osmolar Concentration; D011506:Proteins / Q000378:metabolism; D013997:Time Factors; D015431:Weight Loss
chemical_list: D001647:Bile Acids and Salts; D008055:Lipids; D009077:Mucins; D011506:Proteins; D002784:Cholesterol