Gallbladder bile composition in patients with Crohn 's disease.
OBJECTIVE
To further elucidate the pathogenesis and mechanisms of the high risk of gallstone formation in Crohn's disease.


METHODS
Gallbladder bile was obtained from patients with Crohn's disease who were admitted for elective surgery (17 with ileal/ileocolonic disease and 7 with Crohn's colitis). Fourteen gallstone patients served as controls. Duodenal bile was obtained from ten healthy subjects before and after the treatment with ursodeoxycholic acid. Bile was analyzed for biliary lipids, bile acids, bilirubin, crystals, and crystal detection time (CDT). Cholesterol saturation index was calculated.


RESULTS
The biliary concentration of bilirubin was about 50% higher in patients with Crohn's disease than in patients with cholesterol gallstones. Ten of the patients with Crohn's disease involving ileum and three of those with Crohn's colitis had cholesterol saturated bile. Four patients with ileal disease and one of those with colonic disease displayed cholesterol crystals in their bile. About 1/3 of the patients with Crohn's disease had a short CDT. Treatment of healthy subjects with ursodeoxycholic acid did not increase the concentration of bilirubin in duodenal bile. Several patients with Crohn's disease, with or without ileal resection/disease had gallbladder bile supersaturated with cholesterol and short CDT and contained cholesterol crystals. The biliary concentration of bilirubin was also increased in patients with Crohn's colitis probably not due to bile acid malabsorption.


CONCLUSIONS
Several factors may be of importance for the high risk of developing gallstones of both cholesterol and pigment types in patients with Crohn's disease.
Lapidus
Annika
A
Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden.
Akerlund
Jan-Erik
JE
Einarsson
Curt
C
D000328:Adult; D000368:Aged; D001646:Bile / Q000737:chemistry*; D001663:Bilirubin / Q000032:analysis; D002769:Cholelithiasis / Q000209:etiology; D002784:Cholesterol / Q000737:chemistry; D003424:Crohn Disease / Q000150:complications / Q000378:metabolism*; D003460:Crystallization; D005260:Female; D005704:Gallbladder / Q000737:chemistry*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D014580:Ursodeoxycholic Acid; D002784:Cholesterol; D001663:Bilirubin