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. 2003 Aug;56(8):596-8.
doi: 10.1136/jcp.56.8.596.

Unconjugated bilirubin in human bile: the nucleating factor in cholesterol cholelithiasis?

M K Dutt  1 , G M Murphy, R P H Thompson
Affiliations

Unconjugated bilirubin in human bile: the nucleating factor in cholesterol cholelithiasis?

M K Dutt et al. J Clin Pathol. 2003 Aug.

Abstract

Aims: To investigate the concentrations of bilirubin, bilirubin conjugates, phospholipid, and cholesterol in the gall bladder bile obtained at surgery from patients with and without cholesterol gallstones.

Methods: Gall bladder bile was collected during surgery, by puncture, from 20 patients with gallstones undergoing routine cholecystectomy and from eight patients with normal liver blood tests. Concentrations of bilirubin, bilirubin conjugates, phospholipid, and cholesterol were measured using standard procedures.

Results: The proportion of total bilirubin that was unconjugated was significantly higher in the bile from patients with stones than in bile from control patients, whether or not the bile from either group was saturated with cholesterol or not. Indeed, the mean concentration of cholesterol was significantly higher in control bile samples.

Conclusion: The presence of stones was more closely related to the proportion of unconjugated bilirubin than to the degree of saturation of bile with cholesterol. Bilirubin and its metabolites probably play an important part in the formation of cholesterol gallstones.

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Figures

Figure 1
Figure 1
Biliary bilirubin concentrations in patients with (triangle) and without (circle) predominantly cholesterol gallstones. Medians are shown.
Figure 2
Figure 2
Unconjugated bilirubin (% total) in cholesterol saturated (cholesterol saturation index (CSI) >1.0) and unsaturated (CSI < 1.0) bile samples from patients with and without gallstones.
See this image and copyright information in PMC

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