Postgrad Med. 1991 Oct;90(5):119-26. Related Articles, Books, LinkOut

Gallstone symptoms. Myth and reality.

Egbert AM.

Department of Internal Medicine, University of Kansas School of Medicine,
Wichita 67214-3199.

Gallstones are very common, but at least two thirds of detected stones are
asymptomatic and a large number undoubtedly go undetected. The presence of
symptoms or complications is the indication for surgery. It is important to
accurately identify which symptoms are caused by gallstones, because
removing the gallbladder will relieve only these symptoms. Making this
determination is a challenge, however, because the classic picture of
biliary colic may be inaccurate and the connection between gallstone disease
and flatulent dyspepsia is questionable at best. Descriptions of both these
conditions are based on anecdotal evidence or reports of uncontrolled
surgical series. A review of recent controlled trials suggests that the pain
of biliary colic is constant and infrequent, comes in episodes lasting 1 to
5 hours, is located in the epigastrium or right upper quadrant of the
abdomen, and characteristically occurs at night. There are few additional
symptoms other than nausea or vomiting, and colic is not induced by eating
fatty meals. Flatulent dyspepsia--a symptom complex of vague pain in the
right upper quadrant, fatty-food intolerance, and bloating--is probably not
related to the presence of gallstones in the majority of patients.

PMID: 1924000 [PubMed - indexed for MEDLINE]

Nutrition. 2005 Mar;21(3):339-47. Related Articles, Books, LinkOut

Effect of the type of dietary fat on biliary lipid composition and bile
lithogenicity in humans with cholesterol gallstone disease.

Yago MD, Gonzalez V, Serrano P, Calpena R, Martinez MA, Martinez-Victoria E,
Manas M.

Institute of Nutrition and Food Technology, Department of Physiology,
University of Granada, Granada, Spain.

OBJECTIVE: The effect of the type of dietary fat on bile lipids and
lithogenicity is unclear. This study compared the effects of two dietary
oils that differed in fatty acid profile on biliary lipid composition in
humans. METHODS: Female patients who had cholesterol gallstones and were
scheduled for elective cholecystectomy were studied. For 30 d before
surgery, subjects were kept on diets that contained olive oil (olive oil
group, n = 9) or sunflower oil (sunflower oil group, n = 9) as the main
source of fat. Gallbladder bile and stones were sampled at surgery. After
cholecystectomy, duodenal samples were collected by nasoduodenal intubation
during fasting and after administration of mixed liquid meals that included
the corresponding dietary oil. Duodenal and gallbladder bile samples were
analyzed for cholesterol, phospholipids, and total bile acids by established
methods. Individual bile acid conjugates in gallbladder bile were measured
by high-performance liquid chromatography. Gallstones were analyzed by
semiquantitative polarizing light microscopy. RESULTS: Despite marked
differences in the absolute concentration of biliary lipids and total lipid
content, manipulation of dietary fat ingestion did not influence the
cholesterol saturation or the profile of individual bile acids in
gallbladder bile obtained from patients who had gallstones. All but one
subject had mixed cholesterol stones. A cholesterol saturation index of
hepatic bile in fasted cholecystectomized patients was similar in both
dietary groups and indicative of supersaturation. In response to the test
meal, the cholesterol saturation index decreased significantly in patients
given the olive oil diet, reaching values lower than one at 120 min
postprandially. In contrast, hepatic bile secreted by patients who consumed
sunflower oil appeared supersaturated (cholesterol saturation index >1.5)
throughout the experiment. CONCLUSIONS: Our results suggest that the type of
dietary fat habitually consumed can influence bile composition in humans. In
gallbladder, this influence was noted in the presence of more concentrated
bile in the olive oil group. However, this was not translated into a
modification of cholesterol saturation, which is likely due to the fact that
cholesterol gallstones were present by the time the dietary intervention
started. The finding that a typical postprandial variation in hepatic bile
lithogenicity occurred only in olive oil patients was revealing. While
keeping in mind the methodologic limitations of this part of the study, some
gastrointestinal and metabolic mechanisms for this effect are discussed.

PMID: 15797676 [PubMed - in process]