Gallstones: Pathophysiology and Dissolution

Abstract

Gallstones are composed predominantly of cholesterol, a water-insoluble lipid normally present in bile. Bile acids and lecithin in an aqueous medium aggregate to form mixed micelles, within which cholesterol can be solubilized. Most patients with gallstones have a deficiency of bile acids characterized by a decrease in the ratio of bile acids and lecithin to cholesterol in bile and a decrease in the total bile acid pool size. Ingestion of chenodeoxycholic acid corrects these abnormalities, and initial observations have demonstrated gallstone dissolution.