BILIRUBIN CONJUGATE CHANGES IN THE BILE OF GALLBLADDERS CONTAINING GALLSTONES

Gallbladder bile was obtained at laparoscopic cholecystectomy from 31 patients with gallstones, and duodenal aspirates from 18 normal contro ls, Bile pigments (9 conjugates and unconjugated bilirubin) were analy zed by high-performance liquid chromatography. The average proportiona l composition of the bile pigments from the patients with gallstones w as characteristically diffrent from the controls. Whereas the average values for the principal conjugates in the controls were bilirubin dig lucuronide 83.4%, bilirubin monoglucuronide 10.1%, bilirubin monoglucu ronide monoglucoside 4.5%, and bilirubin monoglucuronide monoxyloside 1.0%, the corresponding values in the biles from the patients with gal lstones were 66.3%, 20.6%, 6.5%, and 2.8%, respectively. Values from t he more minor conjugates and unconjugated bilirubin were less than 2% in either data set. In samples obtained in 9 of the gallstone patients early and late in the procedure, no significant change was found. Ove r the spectrum or findings in the gallstone patients, as the proportio n of bilirubin diglucuronide became smaller, that of bilirubin monoglu curonide increased substantially, whereas those of bilirubin monoglucu ronide monoglucoside and bilirubin monoglucuronide monoxyloside increa sed to a small extent. The findings suggest that bilirubin diglucuroni de hydrolysis occurs in the gallbladder bile of gallstone patients, wi th the production of bilirubin monoglucuronide, and that if further hy drolysis of bilirubin monoglucuronide occurs with the formation of unc onjugated bilirubin, the latter does not ordinarily increase because i t is being absorbed. Stasis with increased gallbladder residence time was likely present ill some of the patients. The hydrolytic activity i s hypothesized to arise from the gallbladder wall, or the process to b e spontaneous, and its effects to he amplified by any increase in gall bladder residence time.