title: Composition of gallbladder bile in healthy individuals and patients with gallstone disease from north and South India.
abstract: BACKGROUND
  Gallstones (GS) in south India (SI) are predominantly pure pigment or mixed, while in North India (NI), these are either pure cholesterol or mixed. While cholesterol rich gallbladder (GB) bile predicts cholesterol GS, constituent of bile in primary pigment GS is not known. We compared the composition of GB bile from healthy liver donors and patients with GS from north and south India.
  
  
  METHODS
  Gallbladder bile from healthy liver donors from north (10) and south India (8) served as controls. Cases were patients from north (21) and south India (17) who underwent cholecystectomy for GS disease. Gallbladder bile from both cases and controls was analyzed for cholesterol, lecithin (phospholipid), and bile salts. Gallstones were classified as cholesterol, mixed, and pigment based on morphology and biochemical analysis.
  
  
  RESULTS
  The median cholesterol concentration in control bile from north was significantly high compared to south (p<0.001) with no difference in lecithin and bile salts (p NS). Except for one sample each from north and south, the cholesterol solubility of controls was within the critical micellar zone. Mixed GS were most frequent in north India (61.9 %) while pigment GS dominated in south (61.9 %). The median cholesterol concentration in bile samples of cholecystectomy patients from north India was significantly high GS (p < 0.00001) with significant lowering of bile salts and lecithin (p < 0.00001). In south India, patients with mixed GS had high cholesterol content in bile compared to controls and patients with pigment GS; bile in latter had significantly higher concentration of bile salt compared to controls and mixed GS. The ternary plot confirmed the composition of GB bile from north and south India.
  
  
  CONCLUSIONS
  Gallbladder bile in controls and patients with GS from north India had significantly high cholesterol concentration. In south India, patients with mixed GS had cholesterol rich bile while pigment GS had higher concentrations of bile salts.
authors.affiliation: Gastroenterology and Hepatology, Institute of Gastrosciences, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India. drjayanthi35@yahoo.co.in.
authors.forename: V
authors.initials: V
authors.lastname: Jayanthi
authors.affiliation: Crystal Growth Center, AC Technology, University of Madras, Chepauk, Chennai, 600 005, India.
authors.forename: S
authors.initials: S
authors.lastname: Sarika
authors.affiliation: Institute of Liver Disease and Liver Transplant, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India.
authors.forename: Joy
authors.initials: J
authors.lastname: Varghese
authors.affiliation: Gastroenterology and Hepatology, Institute of Gastrosciences, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India.
authors.forename: V
authors.initials: V
authors.lastname: Vaithiswaran
authors.affiliation: Jaswant Rai Specialty Hospital, Mawana Road, Meerut, 250 001, India.
authors.forename: Malay
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Institute of Liver Disease and Liver Transplant, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India.
authors.forename: Mettu Srinivas
authors.initials: MS
authors.lastname: Reddy
authors.affiliation: Gastroenterology and Hepatology, Institute of Gastrosciences, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Srinivasan
authors.affiliation: Chettinad Hospital and Research Institute, Rajiv Gandhi Salai, OMR Chennai, Kelambakkam, Chennai, 603 103, India.
authors.forename: G M M
authors.initials: GM
authors.lastname: Reddy
authors.affiliation: Institute of Liver Disease and Liver Transplant, Global Health City, 439, Cheran Nagar, Chennai, 600 100, India.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
authors.affiliation: Crystal Growth Center, AC Technology, University of Madras, Chepauk, Chennai, 600 005, India.
authors.forename: S
authors.initials: S
authors.lastname: Kalkura
mesh_terms: D001646:Bile / Q000737:chemistry* / Q000378:metabolism*; D001647:Bile Acids and Salts / Q000032:analysis*; D002784:Cholesterol / Q000032:analysis*; D005704:Gallbladder / Q000378:metabolism*; D042882:Gallstones / Q000737:chemistry* / Q000145:classification / Q000378:metabolism*; D006801:Humans; D007194:India; D054709:Lecithins / Q000032:analysis*
chemical_list: D001647:Bile Acids and Salts; D054709:Lecithins; D002784:Cholesterol
keywords: Bile acids; Bile salts; Cholesterol; Gallstone disease; Healthy gallbladder bile; Lecithin