Human gallbladder bile becomes lithogenic during short-term intravenous hyperalimentation

Biliary sludge formation is reported to be one of the complications of intravenous hyperalimentation (IVH); however, the change in human biliary lithogenicity during IVH treatment has been little studied. To clarify the pathogenesis of IVH-induced biliary sludge, we determined biliary lipid composition, vesicular cholesterol concentration, and nucleation time using gallbladder bile samples collected from three groups: The IVH group comprised 9 patients who received IVH with fasting for a period of 2-8 days prior to surgery for gastrointestinal diseases. The control group comprised 10 patients operated after overnight fasting for gastro-intestinal diseases. The cholesterol gallstone group comprised 14 patients surgically treated for cholesterol gallstone disease after overnight fasting. The nucleation time in the IVH group was significantly shorter (7.8 ± 5.3 days, mean ± SD) than that in the control group (17.3 ± 5.5 days), while it did not reach the value in the cholesterol gallstone group (3.1 ± 3.3 days). The cholesterol saturation index in the IVH group (1.01 ± 0.27) was higher but not significantly different compared with the control group (0.80 ± 0.21). The concentrations of biliary lipids and individual bile acid were similar in the IVH and control groups. The vesicular cholesterol concentration in the IVH group (3.0 ± 2.1 mM) was significantly higher than that in the control group (0.9 ± 1.0 mM). In conclusion, IVH with fasting causes a rapid cholesterol nucleation time and a higher vesicular cholesterol concentration, thereby inducing an initial stage of gallbladder sludge formation.