Cholesterol nucleation time in gallbladder bile of patients with solitary or multiple cholesterol gallstones

Authors

  • Dieter Jüngst M.D.,

    Corresponding author
    1. Department of Medicine II, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, 8000 Munich 70, Germany
    • Department of Medicine II, Klinikum Grosshadern, Marchioninistr. 15, 8000 Munich 70, Germany
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  • Thomas Lang,

    1. Department of Medicine II, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, 8000 Munich 70, Germany
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  • Christoph von Ritter,

    1. Department of Medicine II, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, 8000 Munich 70, Germany
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  • Ekkehard Pratschke,

    1. Department of Medicine II, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, 8000 Munich 70, Germany
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  • Gustav Paumgartner

    1. Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, 8000 Munich 70, Germany
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Abstract

Patients with multiple cholesterol gallbladder stones have been found to be at a higher risk for the recurrence of gallstones after successful nonsurgical treatment than those with a solitary stone. Cholesterol gallstone recurrence, like primary gallstone formation, probably involves a triple defect with supersaturation, abnormally rapid nucleation of cholesterol in bile and altered gallbladder motor function. We investigated whether the increased recurrence rate of patients with multiple stones might be caused by more rapid nucleation. Therefore the time required for cholesterol monohydrate crystals to appear in ultracentrifuged bile of patients with solitary (n = 71) or multiple (n = 42) cholesterol gallstones was determined.

The cholesterol nucleation time was significantly (p < 0.01) longer in the bile from patients with solitary stones (< 1 to 16 days, median = 2.0 days) than in the bile from patients with multiple stones (< 1 to 8 days, median = 1.0 days). Moreover, 15 of 71 (21.1%) patients with solitary cholesterol stones but only 1 of 42 (2.4%) patients with multiple cholesterol stones showed a normal (> 4 days) nucleation time.

However, no difference in the cholesterol saturation index was found between the bile samples from patients with solitary stones and the bile samples from patients with multiple stones (1.55 ± 0.65 vs. 1.54 ± 0.59, mean ± S.D., respectively). The more rapid cholesterol nucleation in gallbladder bile may, therefore, be the major risk factor causing the higher percentage of stone recurrence in patients with multiple cholesterol stones as compared with patients with solitary cholesterol stones. (HEPATOLOGY 1992;15:804-808).

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