BILIARY LIPID MASS IN THE GALLBLADDER IN HEALTH AND IN CHOLESTEROL GALLSTONE DISEASE

Citation
Rp. Jazrawi et al., BILIARY LIPID MASS IN THE GALLBLADDER IN HEALTH AND IN CHOLESTEROL GALLSTONE DISEASE, European journal of gastroenterology & hepatology, 5(5), 1993, pp. 373-381
Citations number
NO
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Gastroenterology & Hepatology
ISSN journal
0954-691X
Volume
5
Issue
5
Year of publication
1993
Pages
373 - 381
Database
ISI
SICI code
0954-691X(1993)5:5<373:BLMITG>2.0.ZU;2-7
Abstract
Objectives: A high cholesterol saturation index of gallbladder bile is an essential prerequisite for cholesterol gallstone formation. This c ould be due to a high cholesterol mass, or to a low bile acid and/or p hospholipid mass in gallbladder bile, or to a combination of these abn ormalities. The conventional method of measuring the saturation index cannot distinguish between these alternatives. Our aim was to distingu ish between these alternatives in patients with cholesterol gallstones by measuring biliary lipid masses, and to study the effect of gender and obesity within this gallstone population. Methods: We have develop ed a simple technique for the measurement of total biliary lipid masse s in the gallbladder. This involves a combination of (TcHIDA)-Tc-99m c holescintigraphy and of nasoduodenal intubation with intravenous chole cystokinin infusion to obtain a bile sample. We validated this techniq ue by comparing it with direct measurement of biliary lipid masses fol lowing cholecystectomy; we studied 19 male non-obese healthy controls and a total of 45 gallstone patients, who were further subdivided into male non-obese (n = 13), female non-obese (n = 17) and obese (n = 15) gallstone patients. Results: The validation studies showed close agre ement for all three biliary lipids between our technique and the direc t measurements. The male non-obese gallstone patients had a significan tly higher saturation index than the male non-obese healthy controls. This was due to a reduction in bile acid mass (2.73 versus 4.79 mmol, P < 0.005), with no difference in the masses of phospholipid or choles terol. There were no differences between male and female non-obese gal lstone patients; and obese patients had a reduced phospholipid mass as well as a reduced bile acid mass. There was no increase in cholestero l mass within the gallbladder in any of the groups. Conclusions: We co nclude that (TcHIDA)-Tc-99m scintigraphy together with nasoduodenal in tubation provides a simple valid technique for measuring biliary lipid masses in the gallbladder; that the main defect in gallstone disease is a reduction in bile acid mass; that within the gallstone population , gender has no effect on biliary lipid masses, but that obese gallsto ne patients have a reduction in phospholipid mass also. There was no i ncrease in cholesterol mass in the gallbladder in any of the gallstone groups, presumably because this was prevented by the low bile acid ma ss.