LEADING ARTICLE
Cholesterol crystallisation in bile
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Introduction |
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Cholesterol gallstones occur when at least three simultaneous defects are present: (i) cholesterol supersaturation of bile with formation of cholesterol-rich unstable vesicles; (ii) accelerated crystallisation of cholesterol in bile owing to a defect of crystallisation inhibiting or an abundance of crystallisation promoting factors; and (iii) prolonged bile stasis due to decreased gall bladder motility.1
Precipitation of solid cholesterol crystals from supersaturated bile
has an essential role in cholesterol gallstone
formation.2 3
The number of days it takes before
microscopic plate-like cholesterol monohydrate crystals are observed in
human bile has been referred to as the crystal nucleation
time.2 This term, however, indicates early aggregation of
cholesterol molecules from supersaturated bile into submicroscopic
nuclei.4 This crucial step is followed by precipitation,
growth and agglomeration of cholesterol crystals, which then become
visible at light microscopy. In this respect, the term crystal
detection time seems more appropriate than crystal nucleation
time.5 Recent data indicate that
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