This report presents a comparative study of gallstone and gallbladder bile composition from 100 unselected American patients, 23 with pigment and 77 with cholesterol cholelithiasis. Cholesterol stones were predominantly composed of cholesterol, whereas pigment stones were mainly composed of an unidentified residue, bilirubin, and bile salts. The residue in pigment stones was not calcium bilirubinate, which sharply contrasts with the composition of bile pigment calcium stones found in Japanese subjects. Bile composition of the two groups differed in that the cholesterol content of biles surrounding pigment stones was significantly less than that of biles surrounding cholesterol stones. Bilirubin in biles was conjugated, but the pigment extracted from stones was unconjugated bilirubin. This study indicates that (1) pigment stones account for an appreciable percentage of gallstone specimens found at cholecystectomy, and (2) pigment stone formation involves the precipitation of bilirubin, bile salts, and unidentified material which is not calcium bilirubinate.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Admirand WH, Small DM: The physiochemical basis of cholesterol gallstone formation in man. J Clin Invest 47:1043–1052, 1968.
Small DM: The formation of gallstones. Adv Intern Med 16:243–264, 1970
Vlahcevic ZR, Bell CC Jr, Swell L: Significance of the liver in the production of lithogenic bile in man. Gastroenterology 59:62–69, 1970
Thistle JL, Eckhart KL, Nensel RE, Nobrega FT, Poehling GG, Reimer M, Schoenfield LJ: Prevalence of gallbladder disease among Chippewa Indians. Mayo Clin Proc 46:603–608, 1971
Vlahcevic ZR, Bell CC Jr, Buhac I, Ferrer JT, Swell L: Diminished bile acid pool size in patients with gallstones. Gastroenterology 59:165–173, 1970
Grundy SM, Metzger AL, Adler RD: Mechanisms of lithogenic bile formation in American Indian women with cholesterol gallstones. J Clin Invest 51:3026–3043, 1972
Small DM, Rapo S: Source of abnormal bile in patients with cholesterol gallstones. N Engl J Med 283:53–57, 1970
Nakayama F, van der Linden W: Bile composition: Sweden vs Japan. Am J Surg 122:8–12, 1971
Izumi K: Studies on the chemical composition of gallbladder bile and gallstone; especially on the difference in the process of gallstone formation between cholesterol stone and bile pigment stone. Fukuoka Acta Med 56:488–523, 1965
Nakayama F, van der Linden W: Bile from gallbladder harbouring gallstone: Can it indicate stone formation? Acta Chir Scand 136:605–610, 1970
Dam H, Kruse I, Kallehauge HE, Hartkopp OE, Krogh Jensen M: Studies on human bile. 1. Composition of bladder bile from cholelithiasis patients with normal bile compared with data for bladder bile of hamsters on different diets. Scand J Clin Lab Invest 18:385–404, 1966
Fiske CH, Subbarow Y: The colorimetric determination of phosphorus. J Biol Chem 66:375–400, 1925
Michaelsson M: Bilirubin determination in serum and urine. Studies on diazo methods and a new copper-diazo pigment method. Scand J Clin Lab Invest (Suppl) 56:40–50, 1961
Abell LL, Levy BB, Brodie BB, Kendall FE: A simplified method for estimation of total cholesterol in serum and demonstration of its specificity. J Biol Chem 195:357–366, 1952
Talalay P: Enzymatic analysis of steroid hormones. Methods Biochem Anal 8:119–143, 1960
Schoenfield LJ, Sjövall J, Sjövall K: Bile acid composition of gallstones from man. J Lab Clin Med 68:186–194, 1966
Nakayama F: Quantitative microanalysis of gallstones. J Lab Clin Med 72:602–611, 1969
Weber AP, Schalm L: Quantitative separation and determination of bilirubin and conjugated bilirubin in human serum. Clin Chim Acta 7:805–810, 1962
Thompson RPH, Hofmann AF: Separation of bilirubin and its conjugates by thin layer chromatography. Clin Chim Acta 35:517–520, 1971
Croxton E: Elementary statistics with application in medicine and the biological sciences. New York, Dover Publication Inc., 1959, pp 1–376
Nakayama F: Studies on calculus versus milieu: Gallstone and bile. J Lab Clin Med 77:366–377, 1971
Friedman GD, Kannel WB, Dawler TR: The epidemiology of gallstone disease: Observations in the Framingham study. J Chronic Dis 19:273–292, 1966
Rains AJH: Gallstones: Causes and treatment. Springfield, Illinois, Charles C Thomas, 1966, Chapter III
Suzuki N, Toyoda M: On infrared absorption spectra of bilirubin and calcium bilirubinate. Tohoku J Exp Med 88:353–360, 1966
Shaffer EA, Braasch JW, Small DM: Bile composition at and after surgery in normal persons and patients with gallstones. N Engl J Med 287:1317–1322, 1972
Heller F, Bouchier IAD: Cholesterol and bile salt studies on bile of patients with cholesterol gallstones. Gut 14:83–88, 1973
Fevery J, Van Damme B, Michiels R, DeGroote J, Heirwegh KPM: Bilirubin conjugates in bile of man and rat in the normal state and in liver disease. J Clin Invest 51:2482–2492, 1972
Ostrow JD: Photocatabolism of labeled bilirubin in congenitally jaundiced (Gunn) rat. J Clin Invest 50:707–718, 1971
Callahan EW Jr, Schmid R: Excretion of unconjugated bilirubin in the bile of Gunn rats. Gastroenterology 57:134–137, 1969
Maki T: Pathogenesis of calcium bilirubinate gallstone. Role ofE. coli, β-glucuronidase and coagulation of inorganic ions, polyelectrolytes and agitation Ann Surg 164:90–100, 1966
About this article
Cite this article
Trotman, B.W., Ostrow, J.D., Soloway, R.D. et al. Pigment vs cholesterol cholelithiasis: Comparison of stone and bile composition. Digest Dis Sci 19, 585–590 (1974). https://doi.org/10.1007/BF01073011
- Bile Salt
- Stone Formation
- Japanese Subject