Skip to main content
NCBI home page
Gut logoLink to Gut
. 1972 Jun;13(6):415–420. doi: 10.1136/gut.13.6.415

Lithogenic bile in patients with ileal dysfunction 1

R Hermon Dowling, G Duncan Bell, June White
PMCID: PMC1412201  PMID: 5040830

Abstract

Ileal disease or resection causes bile salt malabsorption and a reduction in the bile salt content of bile. Since cholesterol solubility requires adequate bile salt concentrations, depletion of the bile salt content of bile might, therefore, jeopardize cholesterol solubility and predispose to cholesterol gallstone formation.

To study this, we examined biliary lipid composition in 10 patients with ileal dysfunction and in 25 healthy controls.

Biliary lipid composition, as analysed in cholecystokinin-stimulated, bile-rich duodenal fluid, was shown to be representative of gallbladder bile and reproducible on repeat duodenal intubation.

Nine of the 10 patients with ileal dysfunction had an abnormal, supersaturated bile in which the limits of cholesterol solubility were exceeded, and while nine of 25 control subjects also had an unstable bile, the mean bile composition in the ileal dysfunction group was significantly different from the control population.

These studies provide a physicochemical explanation for the clinical observation that patients with ileal dysfunction have an increased incidence of gallstones.

Full text

PDF
415

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Admirand W. H., Small D. M. The physicochemical basis of cholesterol gallstone formation in man. J Clin Invest. 1968 May;47(5):1043–1052. doi: 10.1172/JCI105794. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bouchier I. A., Cooperband S. R., el-Kodsi B. M. Mucous substances and viscosity of normal and pathological human bile. Gastroenterology. 1965 Oct;49(4):343–353. [PubMed] [Google Scholar]
  3. Cohen S., Kpplan M., Gottlieb L., Patterson J. Liver disease and gallstones in regional enteritis. Gastroenterology. 1971 Feb;60(2):237–245. [PubMed] [Google Scholar]
  4. Dowling R. H., Mack E., Small D. M. Biliary lipid secretion and bile composition after acute and chronic interruption of the enterohepatic circulation in the Rhesus monkey. IV. Primate biliary physiology. J Clin Invest. 1971 Sep;50(9):1917–1926. doi: 10.1172/JCI106684. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dowling R. H., Mack E., Small D. M. Effects of controlled interruption of the enterohepatic circulation of bile salts by biliary diversion and by ileal resection on bile salt secretion, synthesis, and pool size in the rhesus monkey. J Clin Invest. 1970 Feb;49(2):232–242. doi: 10.1172/JCI106232. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Heaton K. W., Read A. E. Gall stones in patients with disorders of the terminal ileum and disturbed bile salt metabolism. Br Med J. 1969 Aug 30;3(5669):494–496. doi: 10.1136/bmj.3.5669.494. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. JUNIPER K., Jr, BURSON E. N., Jr Biliary tract studies. II. The significance of biliary crystals. Gastroenterology. 1957 Feb;32(2):175-208; discussion, 208-11. [PubMed] [Google Scholar]
  8. Nilsson S., Scherstén T. Importance of bile acids for phospholipid secretion into human hepatic bile. Gastroenterology. 1969 Nov;57(5):525–532. [PubMed] [Google Scholar]
  9. Nilsson S., Scherstén T. Influence of bile acids on the synthesis of biliary phospholipids in man. Eur J Clin Invest. 1970 Aug;1(2):109–111. doi: 10.1111/j.1365-2362.1970.tb00606.x. [DOI] [PubMed] [Google Scholar]
  10. PLAYOUST M. R., LACK L., WEINER I. M. EFFECT OF INTESTINAL RESECTION ON BILE SALT ABSORPTION IN DOGS. Am J Physiol. 1965 Feb;208:363–369. doi: 10.1152/ajplegacy.1965.208.2.363. [DOI] [PubMed] [Google Scholar]
  11. Small D. M., Rapo S. Source of abnormal bile in patients with cholesterol gallstones. N Engl J Med. 1970 Jul 9;283(2):53–57. doi: 10.1056/NEJM197007092830201. [DOI] [PubMed] [Google Scholar]
  12. Swell L., Bell C. C., Jr, Entenman C. Bile acids and lipid metabolism. 3. Influence of bile acids on phospholipids in liver and bile of the isolated perfused dog liver. Biochim Biophys Acta. 1968 Oct 22;164(2):278–284. [PubMed] [Google Scholar]
  13. Thistle J. L., Schoenfield L. J. Induced alterations in composition of bile of persons having cholelithiasis. Gastroenterology. 1971 Oct;61(4):488–496. [PubMed] [Google Scholar]
  14. Vlahcevic Z. R., Bell C. C., Jr, Buhac I., Farrar J. T., Swell L. Diminished bile acid pool size in patients with gallstones. Gastroenterology. 1970 Aug;59(2):165–173. [PubMed] [Google Scholar]
  15. Vlahcevic Z. R., Bell C. C., Jr, Juttijudata P., Swell L. Bile-rich duodenal fluid as an indicator of biliary lipid composition and its applicability to detection of lithogenic bile. Am J Dig Dis. 1971 Sep;16(9):797–802. doi: 10.1007/BF02239307. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES