Bile composition in patients with cholesterol gallstones and its alteration by chenodeoxycholic acid therapy

Abstract

Duodenal bile was collected from 28 patients with cholesterol gallstones and 11 control subjects, and analyzed for lipids (bile acid, lecithin and cholesterol), bile acid composition and ratio of glycine-to taurine conjugated bile acids (G/T). Fifteen of the patients with gallstones were treated with a daily dose of 500 mg or 300 mg chenodeoxycholate (CDCA), and their duodenal bile was similarly analyzed for its composition after three months of treatment. Fasting serum bile acid was determined in eight patients treated with CDCA before and at the end of three months' treatment.
The ratio of bile acid plus lecithin to cholesterol and that of bile acid to cholesterol tended to be lower in patients with cholesterol gallstones. There was no significant difference in bile acid composition and G/T in the bile between patients with cholesterol gallstones and control subjects.
The ratio of bile acid plus lecithin to cholesterol and that of bile acid to cholesterol were significantly increased by both doses of 500mg and 300mg of CDCA, but the increase was more significant with 500 mg. The proportion of chenodeoxycholic acid in the bile acid composition was increased by CDCA treatment. The ratio of lithocholic acid to total bile acid did not significantly change in the bile after three months of treatment. Between 500mg and 300mg doses there was no significant difference in bile acid composition excluding
ursodeoxycholic acid after treatment. The values of G/T and fasting serum bile acid were not significantly altered by CDCA treatment.
These observations suggest that the 500 mg dose for CDCA treatment improves the cholesterol solubilizing capacity of the bile to such an extent as to dissolve cholesterol gallstones in the patient.