Sluggish small bowel motility is involved in determining increased biliarydeoxycholic acid in cholesterol gallstone patients

OBJECTIVE: Our aim was to establish whether small intestine transit time is defective in subjects with cholesterol gallstones. METHODS: We enrolled 10 patients (eight women, two men; mean age, 48.7 yr; mean body mass index [BMI], 22.4 Kg/m(2)) with recently diagnosed cholelith iasis, with no liver pathology, who were not taking any drugs, and 11 compa rable healthy volunteers (eight women, three men; mean age, 46.2 yr; mean B MI, 22.7 Kg/m(2)), who served as controls. All subjects underwent orocecal (by starch breath test technique and serum assays of salazopyrin), oroileal (by serum assays of tauroursodeoxycholic acid), and duodenoileal (by serum assays of taurocholic acid) transit times; cholesterol saturation index; a nd bile acid composition and gallbladder motility studies (by ultrasound). For serum assays, blood samples were collected over a period of 7 h. Gallbl adder motility and orocecal transit time were evaluated simultaneously. RESULTS: All four means of assessing transit time gave longer times in chol esterol gallstone patients than in controls: orocecal transit time (salazop yrin) = 366 +/- 13 vs 258 +/- 16 min, p < 0.0005; orocecal transit time (st arch breath test) = 415 +/- 139 vs 290 +/- 15 min, p < 0.01; duodenoileal t ransit time: 272 +/- 23 vs 205 +/- 23 min, p < 0.03; and oroileal transit t ime: 308 +/- 18 vs 230 +/- 19 min, p < 0.009. Cholesterol gallstone patient s showed an increase in percent molar biliary deoxycholic acid (30% +/- 4.5 % vs 16% +/- 1.3%, p < 0.02) and a decrease in percent molar cholic acid 32 % +/- 2.2% vs 40% +/- 1.3%, p < 0.03) and chenodeoxycholic acid (34% +/- 3% vs 41% +/- 1.8%, p < 0.03), compared with controls; patients also bad grea ter percent molar biliary cholesterol. A linear relationship (p = 0.6324, p = 0.0012) between biliary deoxycholic acid and small bowel transit time wa s found. Residual gallbladder volumes:were larger in cholesterol gallstone patients (11.38 +/- 1.27 vs 7.55 +/- 0.39 ml, p < 0.04), whereas basal gall bladder volumes, although higher, did not reach statistical significance (2 4.25 +/- 2.41 vs 19.98 +/- 1.63 mi; p = ns). CONCLUSIONS: This study confirms that patients with cholesterol gallstones have delayed small bowel transit, defective gallbladder motor function, and increased biliary deoxycholic acid. Delayed small bowel transit may contri bute to supersaturation of bile with cholesterol by increasing deoxycholic acid production. (Am J Gastroenterol 1999;94: 2453-2459. (C) 1999 by Am. Co ll. of Gastroenterology).