CHOLESTEROL GALLSTONE FORMATION IN MAN AND POTENTIAL TREATMENTS OF THE GALLBLADDER MOTILITY DEFECT

Cholelithiasis affects 10-15% of the adult population in Western socie ty, and about 75% of gallstones are of cholesterol type. Hepatic hyper secretion of cholesterol with the formation of instable cholesterol-ri ch vesicles in bile, an imbalance between nucleation-inhibiting and nu cleation-promoting proteins with further aggregation of cholesterol cr ystals in a gallbladder with a motility defect (stasis), all play a ro le in the pathogenesis of cholesterol gallstones. Experimental animal models suggest that gallstone formation can be prevented by improving gallbladder emptying. Thus, a better understanding of the causes under lying the impaired gallbladder motor function in patients with gallsto nes might lead to the selection of therapeutic approaches for those in dividuals who are at increased risk for the formation or recurrence of gallstones. The present article focuses on current concepts and theor ies on the pathogenesis of cholesterol gallstones with emphasis on the gallbladder motility defect. Several treatment strategies for the cor rection of gallbladder hypomotility are also discussed.