PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jcinvestThe Journal of Clinical InvestigationCurrent IssueArchiveSubscriptionAbout the Journal
 
J Clin Invest. 1983 March; 71(3): 596–603.
PMCID: PMC436908

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

Abstract

The gallbladder and small intestine are reservoirs for the bile acid pool during its enterohepatic circulation and, as such, may regulate biliary secretion of bile acid. During studies of biliary bile acid secretion, a stimulus to gallbladder contraction is continuously infused into the duodenum. Under these conditions, it is assumed that the gallbladder is tonically contracted and that the rate of bile acid secretion into the duodenum equals the hepatic bile acid secretion rate. However, secretion rates vary by as much as 100%, depending upon which of two standard stimuli is used. Therefore, we studied the role of gallbladder emptying and small intestinal transit in determining biliary lipid secretion rate and composition during infusion of these stimuli in five healthy subjects. Each subject was studied with a liquid formula containing 40% of calories as fat, and with an amino acid solution for 10 h. Bile acid, phospholipid, cholesterol, and markers were measured in duodenal bile and hourly secretion rates were calculated by marker dilution technique. Real-time gallbladder sonographs and serum pancreatic polypeptide levels were obtained every 30 min. Small bowel transit time was estimated levels were obtained every 30 min. Small bowel transit time was estimated by the breath hydrogen response after giving lactulose intraduodenally.

During liquid formula infusion, gallbladder emptying was more complete, small intestinal transit was faster, and pancreatic polypeptide levels were higher. Secretion rates of all lipids were greater and molar percent cholesterol was lower. For the combined data from both infusions, the secretory relationships of cholesterol to bile acid, cholesterol to phospholipid, and phospholipid to bile acid were curvilinear.

We conclude that more complete gallbladder emptying and faster intestinal transit increase the enterohepatic cycling of bile acids and lower the molar percent cholesterol of bile. Some of the fluctuation observed in biliary lipid secretion rates, especially during amino acid infusion, is due to gallbladder refilling and emptying.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Grundy SM, Metzger AL. A physiological method for estimation of hepatic secretion of biliary lipids in man. Gastroenterology. 1972 Jun;62(6):1200–1217. [PubMed]
  • Shaffer EA, Small DM. Biliary lipid secretion in cholesterol gallstone disease. The effect of cholecystectomy and obesity. J Clin Invest. 1977 May;59(5):828–840. [PMC free article] [PubMed]
  • Kern F, Jr, Everson GT, DeMark B, McKinley C, Showalter R, Erfling W, Braverman DZ, Szczepanik-van Leeuwen P, Klein PD. Biliary lipids, bile acids, and gallbladder function in the human female. Effects of pregnancy and the ovulatory cycle. J Clin Invest. 1981 Nov;68(5):1229–1242. [PMC free article] [PubMed]
  • Go VL, Hofmann AF, Summerskill WH. Pancreozymin bioassay in man based on pancreatic enzyme secretion: potency of specific amino acids and other digestive products. J Clin Invest. 1970 Aug;49(8):1558–1564. [PMC free article] [PubMed]
  • Mok HY, von Bergmann K, Grundy SM. Effects of continuous and intermittent feeding on biliary lipid outputs in man: application for measurements of intestinal absorption of cholesterol and bile acids. J Lipid Res. 1979 Mar;20(3):389–398. [PubMed]
  • Northfield TC, Hofmann AF. Biliary lipid output during three meals and an overnight fast. I. Relationship to bile acid pool size and cholesterol saturation of bile in gallstone and control subjects. Gut. 1975 Jan;16(1):1–11. [PMC free article] [PubMed]
  • LaRusso NF, Szczepanik PA, Hofmann AF. Effect of deoxycholic acid ingestion on bile acid metabolism and biliary lipid secretion in normal subjects. Gastroenterology. 1977 Jan;72(1):132–140. [PubMed]
  • Mok HY, Von Bergmann K, Grundy SM. Kinetics of the enterohepatic circulation during fasting: biliary lipid secretion and gallbladder storage. Gastroenterology. 1980 May;78(5 Pt 1):1023–1033. [PubMed]
  • LaRusso NF, Hoffman NE, Hofmann AF, Northfield TC, Thistle JL. Effect of primary bile acid ingestion on bile acid metabolism and biliary lipid secretion in gallstone patients. Gastroenterology. 1975 Dec;69(6):1301–1314. [PubMed]
  • Krag E, Phillips SF. Active and passive bile acid absorption in man. Perfusion studies of the ileum and jejunum. J Clin Invest. 1974 Jun;53(6):1686–1694. [PMC free article] [PubMed]
  • Lindblad L, Lundholm K, Scherstén T. Influence of cholic and chenodeoxycholic acid on biliary cholesterol secretion in man. Eur J Clin Invest. 1977 Oct;7(5):383–388. [PubMed]
  • Wagner CI, Trotman BW, Soloway RD. Kinetic analysis of biliary lipid excretion in man and dog. J Clin Invest. 1976 Feb;57(2):473–477. [PMC free article] [PubMed]
  • Nilsson S, Scherstén T. Importance of bile acids for phospholipid secretion into human hepatic bile. Gastroenterology. 1969 Nov;57(5):525–532. [PubMed]
  • Metzger AL, Adler R, Heymsfield S, Grundy SM. Diurnal variation in biliary lipid composition. Possible role in cholesterol gallstone formation. N Engl J Med. 1973 Feb 15;288(7):333–336. [PubMed]
  • Bond JH, Jr, Levitt MD, Prentiss R. Investigation of small bowel transit time in man utilizing pulmonary hydrogen (H2) measurements. J Lab Clin Med. 1975 Apr;85(4):546–555. [PubMed]
  • HURLOCK B, TALALAY P. Principles of the enzymatic measurement of steroids. J Biol Chem. 1957 Jul;227(1):37–52. [PubMed]
  • BARTLETT GR. Phosphorus assay in column chromatography. J Biol Chem. 1959 Mar;234(3):466–468. [PubMed]
  • SELIGSON D, MARINO J, DODSON E. Determination of sulfobromophthalein in serum. Clin Chem. 1957 Oct;3(5):638–645. [PubMed]
  • Kern F, Jr, Eriksson H, Curstedt T, Sjövall J. Effect of ethynylestradiol on biliary excretion of bile acids, phosphatidylcolines, and cholesterol in the bile fistula rat. J Lipid Res. 1977 Sep;18(5):623–634. [PubMed]
  • Grundy SM, Ahrens EH, Jr, Salen G. Dietary beta-sitosterol as an internal standard to correct for cholesterol losses in sterol balance studies. J Lipid Res. 1968 May;9(3):374–387. [PubMed]
  • Everson GT, Braverman DZ, Johnson ML, Kern F., Jr A critical evaluation of real-time ultrasonography for the study of gallbladder volume and contraction. Gastroenterology. 1980 Jul;79(1):40–46. [PubMed]
  • Bond JH, Levitt MD. Use of breath hydrogen (H2) to quantitate small bowel transit time following partial gastrectomy. J Lab Clin Med. 1977 Jul;90(1):30–36. [PubMed]
  • Schwartz CC, Almond HR, Vlahcevic ZR, Swell L. Bile acid metabolism in cirrhosis. V. Determination of biliary lipid secretion rates in patients with advanced cirrhosis. Gastroenterology. 1979 Dec;77(6):1177–1182. [PubMed]
  • Bennion LJ, Mott DM, Howard BV. Oral contraceptives raise the cholesterol saturation of bile by increasing biliary cholesterol secretion. Metabolism. 1980 Jan;29(1):18–22. [PubMed]
  • Grundy SM, Duane WC, Adler RD, Aron JM, Metzger AL. Biliary lipid outputs in young women with cholesterol gallstones. Metabolism. 1974 Jan;23(1):67–73. [PubMed]
  • Bennion LJ, Grundy SM. Effects of obesity and caloric intake on biliary lipid metabolism in man. J Clin Invest. 1975 Oct;56(4):996–1011. [PMC free article] [PubMed]
  • Mabee TM, Meyer P, DenBesten L, Mason EE. The mechanism of increased gallstone formation in obese human subjects. Surgery. 1976 Apr;79(4):460–468. [PubMed]
  • Valdivieso V, Palma R, Nervi F, Covarrubias C, Severin C, Antezana C. Secretion of biliary lipids in young Chilean women with cholesterol gallstones. Gut. 1979 Nov;20(11):997–1000. [PMC free article] [PubMed]
  • Mok HY, von Bergmann K, Grundy SM. Effects of interruption of enterohepatic circulation on biliary lipid secretion in man. Am J Dig Dis. 1978 Dec;23(12):1067–1075. [PubMed]
  • Key PH, Bonorris GG, Marks JW, Chung A, Schoenfield LJ. Biliary lipid synthesis and secretion in gallstone patients before and during treatment with chenodeoxycholic acid. J Lab Clin Med. 1980 Jun;95(6):816–826. [PubMed]
  • Adler RD, Metzger AL, Grundy SM. Biliary lipid secretion before and after cholecystectomy in American Indians with cholesterol gallstones. Gastroenterology. 1974 Jun;66(6):1212–1217. [PubMed]
  • Almond HR, Vlahcevic ZR, Bell CC, Jr, Gregory DH, Swell L. Bile acid pools, kinetics and biliary lipid composition before and after cholecystectomy. N Engl J Med. 1973 Dec 6;289(23):1213–1216. [PubMed]
  • Einarsson K, Grundy SM. Effects of feeding cholic acid and chenodeoxycholic acid on cholesterol absorption and hepatic secretion of biliary lipids in man. J Lipid Res. 1980 Jan;21(1):23–34. [PubMed]
  • Einarsson KA, Gundy SM, Hardison WG. Enterohepatic circulation rates of cholic acid and chenodeoxycholic acid in man. Gut. 1979 Dec;20(12):1078–1082. [PMC free article] [PubMed]
  • Mok HY, Von Bergmann K, Grundy SM. Regulation of pool size of bile acids in man. Gastroenterology. 1977 Oct;73(4 Pt 1):684–690. [PubMed]
  • Floyd JC., Jr Pancreatic polypeptide. Clin Gastroenterol. 1980 Sep;9(3):657–678. [PubMed]
  • Keane FB, DiMagno EP, Dozois RR, Go VL. Relationships among canine interdigestive exocrine pancreatic and biliary flow, duodenal motor activity, plasma pancreatic polypeptide, and motilin. Gastroenterology. 1980 Feb;78(2):310–316. [PubMed]

Articles from The Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation