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 gastrointestinal 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.