Clinical Research
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 7, 2006; 12(1): 70-74
Published online Jan 7, 2006. doi: 10.3748/wjg.v12.i1.70
Gallbladder bile composition in patients with Crohn’s disease
Annika Lapidus, Jan-Erik Åkerlund, Curt Einarsson
Annika Lapidus, Jan-Erik Åkerlund, Curt Einarsson, Centre of Gastrointestinal Disease, Ersta Hospital, Department of Surgery, Danderyd Hospital and Department of Gastroenterology and Hepatology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
Supported by grants from the Swedish Research Council and Karolinska Institutet
Correspondence to: Dr Curt Einarsson, Department of Medicine, Division of Gastroenterology and Hepatology, K63, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden. curt.einarsson@medhs.ki.se
Telephone: +46-8-5858-0000 Fax: +46-8-5858-2335
Received: May 12, 2005
Revised: May 28, 2005
Accepted: June 2, 2005
Published online: January 7, 2006
Abstract

AIM: To further elucidate the pathogenesis and mechanisms of the high risk of gallstone formation in Crohn’s disease.

METHODS: Gallbladder bile was obtained from patients with Crohn’s disease who were admitted for elective surgery (17 with ileal/ileocolonic disease and 7 with Crohn’s colitis). Fourteen gallstone patients served as controls. Duodenal bile was obtained from ten healthy subjects before and after the treatment with ursodeoxycholic acid. Bile was analyzed for biliary lipids, bile acids, bilirubin, crystals, and crystal detection time (CDT). Cholesterol saturation index was calculated.

RESULTS: The biliary concentration of bilirubin was about 50% higher in patients with Crohn’s disease than in patients with cholesterol gallstones. Ten of the patients with Crohn’s disease involving ileum and three of those with Crohn’s colitis had cholesterol saturated bile. Four patients with ileal disease and one of those with colonic disease displayed cholesterol crystals in their bile. About 1/3 of the patients with Crohn’s disease had a short CDT. Treatment of healthy subjects with ursodeoxycholic acid did not increase the concentration of bilirubin in duodenal bile. Several patients with Crohn’s disease, with or without ileal resection/disease had gallbladder bile supersaturated with cholesterol and short CDT and contained cholesterol crystals. The biliary concentration of bilirubin was also increased in patients with Crohn’s colitis probably not due to bile acid malabsorption.

CONCLUSION: Several factors may be of importance for the high risk of developing gallstones of both cholesterol and pigment types in patients with Crohn’s disease.

Keywords: Bile acid; Biliary lipid composition; Bilirubin; Crohn’s disease; Gallstone disease