HUMAN GALLBLADDER MUCOSAL FUNCTION - EFFECTS ON INTRALUMINAL FLUID AND LIPID-COMPOSITION IN HEALTH AND DISEASE

Gallbladder mucosal absorption of fluid during fasting is a well-known process. Indirect in vivo and recent in vitro evidence for physiologi cally relevant gallbladder absorption of cholesterol and phospholipids from bile has been observed in humans. The present study explored and compared by indirect means the relative efficiences of human gallblad der mucosal absorption of fluid and lipids in health and disease. Bili ary lipids and pigment content were measured in fasting gallbladder bi le samples obtained from gallstone-free controls and from four study g roups: multiple and solitary cholesterol gallstone patients, and morbi dly obese subjects with and without gallstones. Bile salts and pigment content were significantly greater in gallstone-free controls than in all other disease study groups, This was interpreted as evidence of m ore effective gallbladder mucosal fluid absorption in nonobese gallsto ne-free controls compared to that in all other groups, Correlation plo t analyses of biliary lipids showed lower concentrations of phospholip ids than expected from the index bile salt concentrations, The same wa s found for cholesterol concentrations but only in supersaturated samp les, These findings were much more pronounced in gallstone free-contro ls and were accordingly interpreted as evidence of more efficient gall bladder absorption of both phospholipids and cholesterol in controls c ompared with that found in each of the disease study groups, Moreover, impaired gallbladder mucosal function, while invariably associated wi th cholesterol gallstone disease, was not found to be a necessary cons equence of the physical presence of stones. It is concluded that effic ient gallbladder mucosal absorption of both fluid and apolar lipids fr om bile is a normal physiological process that is often seriously impa ired in the presence of either cholesterol gallstone disease or at lea st one of its precursor forms.