Biliary lipid secretion in cholesterol gallstone disease. The effect of cholecystectomy and obesity.

Abstract

A B S T R A C T Cholesterol gallstone disease is in- itiated in a liver which produces abnormal bile with excess cholesterol relative to bile salts and phos- pholipid. To define the responsible secretory mech- anism(s), the rate of biliary lipid secretion was meas- ured by a duodenal marker perfusion technique, while the bile salt pool was simultaneously estimated by isotope dilution. Two groups of control patients ex- pected to have normal biliary lipid composition-14 subjects without hepatobiliary disease and 6 pa- tients with pigment gallstones, were compared to two experimental groups expected to have abnormal bile- 10 nonobese patients with cholesterol gallstones and 7 obese subjects without gallstones. Both control groups had nearly identical biliary lipid secretion rates, and a corresponding low relative molar con- centration of cholesterol. Two different secretory mechanisms were found to be responsible for the abnormal bile in the experimental groups. In the non- obese patients with cholesterol gallstones, bile salt and phospholipid secretion rates were both signifi- cantly reduced. Conversely, the grossly obese sub- jects had an increased cholesterol secretion.