Biliary lipids, bile acids, and gallbladder function in the human female. Effects of pregnancy and the ovulatory cycle.

Abstract

A B S T R A C T To study the events that might lead to an increased risk of cholesterol gallstones, we examined biliary lipid composition and secretion and bile acid composition and kinetics at different stages of pregnancy or ovulation in young, nonobese, healthy women.Lipid composition and bile acid distribution were determined in duodenal fluid obtained in percentage of cholic acid. The pool size of each major bile acid increased in the first trimester. Chenodeoxycholic acid and deoxycholic acid pools, but not cholic acid pools, subsequently decreased. The fractional turnover rate of both primary bile acids was slower during pregnancy. The synthesis rate of chenodeoxycholic but not cholic acid decreased in a linear manner during the first 20 wk of pregnancy. The rate of enterohepatic cycling of the bile acid pool was reduced throughout pregnancy.The volume of the fasting gallbladder and the residual volume after a physiologically stimulated contraction were directly correlated with bile acid pool size. The residual volume was also directly related to total bile acid synthesis.

Reproductive factors and risks of biliary tract cancers and stones: a population-based study in Shanghai, China

“…Breastfeeding was related to a higher risk of gallbladder cancer in a South-American study (Strom et al, 1995), but not to gallbladder or bile duct cancer in a Japanese study (Kato et al, 1989). Although breastfeeding may have an effect through hormonal mechanisms (Bonnar et al, 1975;Braverman et al, 1980;Kern et al, 1982;Tazuma and Kajiyama, 2001;Novacek, 2006), our finding could be due to chance.…”

“…During pregnancy, gallbladder volume increases and the flow of bile decreases, which are precursors to gallstone formation (Everson et al, , 1991. Moreover, elevated oestrogen levels during pregnancy increase cholesterol content in the bile, contributing to biliary stasis (Braverman et al, 1980;Kern et al, 1982;Everson et al, 1982Everson et al, , 1991Novacek, 2006). Pregnancy has also been associated with gallbladder cancer (Lambe et al, 1993;LaVecchia et al, 1993;Moerman et al, 1994;Tavani et al, 1996), but the modifying effect of gallstones and the role of other reproductive factors are not clear.…”

Gallbladder and Small Intestinal Regulation of Biliary Lipid Secretion during Intraduodenal Infusion of Standard Stimuli

“…When similar groups of subjects from different studies are compared, the molar percent cholesterol during continuous liquid formula infusion (2.9±0.9% [24], 3.4±0.4% [25]) is less than that during continuous amino acid infusion (4.3±0.5% [3]). In the present study we have shown a similar difference between the two infusates in the same individual.…”

Mechanisms of gallstone formation in women. Effects of exogenous estrogen (Premarin) and dietary cholesterol on hepatic lipid metabolism.

“…For example, gallbladder volume increases during late pregnancy (10)(11)(12), and the emptying ofthe gallbladder is slowed by pregnancy, use ofcontraceptive steroids, (10,13), or progestin (14). The cholesterol content of bile is increased in late pregnancy ( 15) and during use ofcontraceptive steroid mixtures (13,16,17), ethinyl estradiol (18,19), or a combination of conjugated estrogens and medroxyprogesterone (20). In addition, bile acid metabolism is altered by pregnancy (15) and contraceptive steroids (13,17,21).…”

“…The cholesterol content of bile is increased in late pregnancy ( 15) and during use ofcontraceptive steroid mixtures (13,16,17), ethinyl estradiol (18,19), or a combination of conjugated estrogens and medroxyprogesterone (20). In addition, bile acid metabolism is altered by pregnancy (15) and contraceptive steroids (13,17,21). Despite these observations, there have been no comprehensive studies of the effects of estrogen, administered alone, on hepatobiliary function.…”