Source of Abnormal Bile in Patients with Cholesterol Gallstones

Cholesterol gallstones are formed when excess cholesterol precipitates from bile supersaturated with cholesterol. Either the gallbladder, by alteration of the composition of normal hepatic bile, or the liver, by production of an abnormal bile, could be the source of the bile supersaturated by cholesterol. Since cholesterol gallstones are very prevalent among American Indians of the Southwest, we analyzed their gallbladder and hepatic bile to determine which organ is responsible for the disease. The composition of the liquid phase of gallbladder bile indicated that it was saturated with cholesterol, whereas the composition and physical state of hepatic bile indicated that it was a liquid highly supersaturated with cholesterol. Thus, in patients with cholesterol gallstones, the liver apparently secretes a bile supersaturated with cholesterol. This excess cholesterol is precipitated in the gallbladder, where this substance contributes to the production and continued growth of stones.