Gallstones deoxycholic acid

Dietary factors may also be important in gallstone pathogenesis - such as intake of total calories, cholesterol, refined carbohydrates and dietary fibre. As discussed below, the amount of bran, and of other fibre components, in the diet may influence the formation of deoxycholic acid (DCA) in the intestine, its subsequent absorption and its enrichment of bile with DCA conjugates. 

Veysey MJ, Thomas LA, Mallet AI, Jenkins PJ, Besser GM, Wass JA, Murphy GM, Dowling RH. Prolonged large bowel transit increases serum deoxycholic acid a risk factor for octreotide induced gallstones. Gut 1999 44(5) 675—81. 

Enteroliths are concretions of precipitated bile acids which form in the intestinal tract and thus differ from gallstones, which consist mainly of cholesterol, bilirubin, or both. All but two enteroliths of which the composition has been determined have been found to be composed of choleic acid, a molecular coordinate complex of deoxycholic acid, and usually a fatty acid in a proportion of about 8 1. Of the remaining two, one enterolith was found in an afferent gastroenterostomy loop (84) and the other in a diverticulum of the second portion of the duodenum (85). Both of these enteroliths consisted of a mixture of unconjugated primary bile acids, cholic and chenodeoxycho-lic acids. 

By 1900, only deoxycholic acid and cholic acid had been obtained in pure crystalline form. In 1911, Fischer (30) isolated lithocholic acid from a gallstone in the course of his classical studies on the bile pigments. Hyodeoxy-cholic acid was purified by Windaus and Bohne in 1923 (31) and chenodeoxy-cholic acid was rediscovered almost simultaneously by Wieland and Reverey (32) and by Windaus et al. (33) in 1924. 

The natural occurrence of the 5a-epimer of deoxycholic acid was first demonstrated by Danielsson, Kallner, and Sjovall (62). The original isolation of this compound was probably by Kishi (61) who named the unidentified acid lagodeoxycholic acid from rabbit bile. In addition to its occurrence in rabbit bile, allodeoxycholic acid is present in rabbit feces (62) and accumulates as the glycine conjugate in gallstones of rabbits fed cholestanol (168). Allodeoxycholic acid may be synthesized from cholic acid by reactions similar to the preparation of allocholic acid (62,168). 

Thistle, Dissolution of cholesterol gallstones by cheno-deoxycholic acid, N,Engl>J.Med., 286 1 (1972). 

H-12) Gallstones. Most gallstones are composed mainly of cholesterol. Bile salts and phospholipids normally prevent the precipitation of cholesterol, but cholesterol stones may form when the cholesterol/bile salt-phospholipid ratio increases excessively. Cheno-deoxycholate may be used as oral therapy for cholesterol gallstones. It not only provides an extra recirculating source of bile acids but inhibits the rate-limiting step in cholesterol biosynthesis. 

Mosbach and Bevans (134) showed that cholestanol-induced cholecystitis and cholelithiasis could be inhibited by the simultaneous administration of dehydrocholic acid and that the extent of inhibition depended on the relative concentrations of the two steroids. Similar observations were made by Ricci et al, (135). Deoxycholic and cholic acids were also effective inhibitors (136), but hyodeoxycholic acid did not suppress gallstone formation and appeared to increase biliary tract inffammation. Several non-bile acid choleretics were without inhibitory effects (136). Lindelof and van der Linden (32) found that intravenous injections of cholecystokinin every 8 hr did not suppress and may actually have enhanced gallstone formation. The inhibition of cholelithiasis by dehydrocholic, deoxycholic, and cholic acids was not accompanied by a decrease in cholestanol absorption but did result in increased tissue cholestanol levels, suggesting a decrease in the conversion of this sterol to bile acids (134,136). Conversely, methyl testosterone apparently inhibited stone formation by interfering with cholestanol absorption, since tissue and serum levels of cholestanol were reduced (137). Olive oil has been shown to facilitate stone formation (138), perhaps by enhancing cholestanol absorption (137). 

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