{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T15:54:24Z","timestamp":1792166064531,"version":"4.4.0"},"reference-count":22,"publisher":"BMJ","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1980,8]]},"abstract":"<jats:p>Abnormally low activity of hepatic bilirubin UDP-glucuronosyltransferase was found in 25% of 81 unselected patients with gallstones, as compared with only 3% in 35 controls. At the time of cholecystectomy, the stones were taken for analysis in 48 of 81 patients, and a bile sample was obtained in 42 of them. Among the stones, 75% were cholesterol stones, 15% pigment stones, and 10% 'intermediate' stones. Low hepatic conjugating activity was not preferentially associated with a given type of stone. No relation was found between the enzymic deficiency and the biliary cholesterol saturation index. A high proportion of biliary bilirubin monoglucuronide (over 40%) was found in four of seven patients with low transferase activity, as was earlier demonstrated in patients with overt Gilbert's syndrome. Raised biliary bilirubin monoglucuronide was also found in three patients, out of 46, who had normal transferase but raised biliary beta-glucuronidase activity. There was no evidence that deficient bilirubin conjugation could be a consequence of gallstones: the activity of another hepatic microsomal enzyme, glucose 6-phosphatase, taken as a reference, was measured in 12 patients and was always normal. Taking into account the very high frequency of a bilirubin centre in the cholesterol stones (87% of the cases in the present series), it is suggested that the increased proportion in poorly soluble biliary bilirubin monoglucuronide, which was associated with defective conjugation, could act as a trigger for gallstone initiation, regardless of the final composition of the stone.<\/jats:p>","DOI":"10.1136\/gut.21.8.650","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"650-655","source":"Crossref","is-referenced-by-count":27,"title":["Possible role of a defect in hepatic bilirubin glucuronidation in the initiation of cholesterol gallstones."],"prefix":"10.1136","volume":"21","author":[{"given":"P","family":"Duvaldestin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J L","family":"Mahu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J M","family":"Metreau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Arondel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A M","family":"Preaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Berthelot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1980,8,1]]},"reference":[{"key":"ref_1","first-page":"403","volume":"12","author":"Klin, Z.","year":"1974","unstructured":"Z Klin Chem Klin Biochem 1974; 12: 403-7.","journal-title":"Chem Klin Biochem"},{"key":"ref_2","first-page":"602","volume":"72","author":"Danzinger, R.G.; Hofmann, A.F.; Thistle, J.L.","year":"1968","unstructured":"Danzinger RG, Hofmann AF, Thistle JL, Schoenfield J Lab Clin Med 1968; 72: 602-1 1.","journal-title":"Schoenfield J Lab Clin Med"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2809","DOI":"10.1172\/JCI107477","article-title":"Effect of oral chenodeoxycholic acid on bile acid 18Van Roy FP, Meuwissen JATP, De Meuter F, Heirwegh kinetics and biliary lipid composition in women with KPM. Determination of bilirubin in liver homogenates cholelithiasis","volume":"52","author":"L.J.","year":"1973","unstructured":"LJ. Effect of oral chenodeoxycholic acid on bile acid 18Van Roy FP, Meuwissen JATP, De Meuter F, Heirwegh kinetics and biliary lipid composition in women with KPM. Determination of bilirubin in liver homogenates cholelithiasis. J Clin Invest 1973; 52: 2809-21.","journal-title":"J Clin Invest"},{"key":"ref_4","first-page":"109","volume":"31","author":"lser JH; RH, Dowling; HYI, Mok; GD, Bell","year":"1971","unstructured":"lser JH, Dowling RH, Mok HYI, Bell GD. Chenode-Acta 1971; 31: 109-18.","journal-title":"Chenode-Acta"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1056\/NEJM197508212930804","article-title":"oxycholic acid treatment of gallstones. A follow-up 19Rodriguez Garay EA, del Rosario Spetale M, report and analysis of factors influencing response to Morisoli LS. Relationship between bilirubin and therapy","volume":"293","year":"1975","unstructured":"oxycholic acid treatment of gallstones. A follow-up 19Rodriguez Garay EA, del Rosario Spetale M, report and analysis of factors influencing response to Morisoli LS. Relationship between bilirubin and therapy. N Engl J Med 1975; 293: 378-83.","journal-title":"N Engl J Med"},{"key":"ref_6","first-page":"171","article-title":"The physical chemistry of obstructive jaundice","volume":"37","author":"Carey, M.C.; Small, D.M.","year":"1972","unstructured":"Carey MC, Small DM. The physical chemistry of obstructive jaundice. Clin Chim Acta 1972; 37: 171-7.","journal-title":"Clin Chim Acta"},{"key":"ref_7","first-page":"466","article-title":"cholesterol solubility in bile. Relationship to gallstone 20Bartlett GR. Phosphorus assay in column chromatoformation and dissolution in man","volume":"234","author":"J Biol Chem","year":"1978","unstructured":"cholesterol solubility in bile. Relationship to gallstone 20Bartlett GR. Phosphorus assay in column chromatoformation and dissolution in man. J Clin Invest 1978; graphy. J Biol Chem 1959; 234: 466-8.","journal-title":"J Clin Invest; graphy"},{"key":"ref_8","first-page":"809","article-title":"Mechanism of phenobarbital-induced hypercholeresis Cholesterol solubility in bile","volume":"219","author":"Holzbach, R.T.; Marsh, M.; Olszewski, M.; Holan, K.","year":"1970","unstructured":"Holzbach RT, Marsh M, Olszewski M, Holan K. Mechanism of phenobarbital-induced hypercholeresis Cholesterol solubility in bile. Evidence that superin the rat. Am J Physiol 1970; 219: 809-13.","journal-title":"Evidence that superin the rat. Am J Physiol"},{"key":"ref_9","first-page":"1467","article-title":"saturated bile is frequent in healthy man","volume":"22","author":"JL, Duvaldestin P.; D, Dhumeaux; P, Berthelot","year":"1973","unstructured":"saturated bile is frequent in healthy man. J Clin Invest 22Mahu JL, Duvaldestin P, Dhumeaux D, Berthelot P. 1973; 52: 1467-79.","journal-title":"J Clin Invest"},{"key":"ref_10","first-page":"445","article-title":"different pathways","volume":"232","author":"Bateson, M.C.; Ross, P.E.; Murison, J.; Bouchier, I.A.D.","year":"1977","unstructured":"Bateson MC, Ross PE, Murison J, Bouchier IAD. different pathways. Am J Physiol 1977; 232: E445-50.","journal-title":"Am J Physiol"},{"issue":"1 1","key":"ref_11","first-page":"1","article-title":"Comparison of fixed doses of chenodeoxycholic acid 23Thomas PJ, Hofmann AF. A simple calculation of the for gallstone dissolution","volume":"1","year":"1978","unstructured":"Comparison of fixed doses of chenodeoxycholic acid 23Thomas PJ, Hofmann AF. A simple calculation of the for gallstone dissolution. Lancet 1978; 1: 1 1 1 1-4.","journal-title":"Lancet"},{"key":"ref_12","first-page":"11","article-title":"Gallstones: causes and treatment, London: position on rectangular coordinates","volume":"1964","author":"Rains, A.J.H.","unstructured":"Rains AJH. Gallstones: causes and treatment, London: position on rectangular coordinates. (Letter) Gastro-Heinemann, 1964: 11-20.","journal-title":"(Letter) Gastro-Heinemann"},{"key":"ref_13","first-page":"698","volume":"65","author":"enterology","year":"1973","unstructured":"enterology 1973; 65: 698-700."},{"key":"ref_14","first-page":"167","article-title":"Pigment 24Siegel S. Nonparametric statistics for the behavioral gallstones","volume":"72","author":"Soloway, R.D.; Trotman, B.W.; Ostrow, J.D.","year":"1977","unstructured":"Soloway RD, Trotman BW, Ostrow JD. Pigment 24Siegel S. Nonparametric statistics for the behavioral gallstones. Gastroenterology 1977; 72: 167-82.","journal-title":"Gastroenterology"},{"key":"ref_15","first-page":"104","article-title":"sciences","year":"1956","unstructured":"sciences. New York: McGraw-Hill, 1956: 104-1 1."},{"key":"ref_16","first-page":"248","article-title":"P450 content in a surgical population, and the effects","volume":"76","year":"1979","unstructured":"P450 content in a surgical population, and the effects 1979; 76: 248-52."},{"key":"ref_17","article-title":"of preoperative drug therapy","year":"1973","unstructured":"of preoperative drug therapy. J Lab Clin Med 1973; 26Boonyapisit ST, Trotman BW, Ostrow JD. Uncon-","journal-title":"J Lab Clin Med; 26Boonyapisit ST, Trotman BW, Ostrow JD"},{"key":"ref_18","first-page":"70","article-title":"Unconjugated bilirubin and an increased lithiasis","volume":"74","author":"Berthelot, P.","year":"1978","unstructured":"Berthelot P. Unconjugated bilirubin and an increased lithiasis. Gastroenterology 1978; 74: 70-4.","journal-title":"Gastroenterology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1172\/JCI108877","article-title":"proportion of monoconjugates in the bile of patients 27Foulk WT, Butt HR, Owen CA Jr, Whitcomb FF Jr, with Gilbert's syndrome and Crigler-Najjar disease. Mason HL. Constitutional hepatic dysfunction","volume":"60","year":"1977","unstructured":"proportion of monoconjugates in the bile of patients 27Foulk WT, Butt HR, Owen CA Jr, Whitcomb FF Jr, with Gilbert's syndrome and Crigler-Najjar disease. Mason HL. Constitutional hepatic dysfunction J Clin Invest 1977; 60: 970-9.","journal-title":"J Clin Invest"},{"key":"ref_20","first-page":"25","article-title":"Effect of fasting syndromes","volume":"38","author":"Duvaldestin, P.; Mahu, J.L.; Berthelot, P.","year":"1959","unstructured":"Duvaldestin P, Mahu JL, Berthelot P. Effect of fasting syndromes. Medicine (Baltimore) 1959; 38: 25-46.","journal-title":"Medicine (Baltimore)"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/0005-2744(75)90097-2","article-title":"on substrate specificity of rat liver UDP-glucurono-28Holan KR, Holzbach RT, Hermann RE, Cooperman syltransferase","volume":"384","year":"1975","unstructured":"on substrate specificity of rat liver UDP-glucurono-28Holan KR, Holzbach RT, Hermann RE, Cooperman syltransferase. Biochim Biophys Acta 1975; 384: 81-6. AM, Claffey WJ. Nucleation time: a key factor in","journal-title":"Biochim Biophys Acta; AM, Claffey WJ. Nucleation time: a key factor in"},{"key":"ref_22","first-page":"611","article-title":"Bilirubin conjugates in bile","volume-title":"of man Gastroenterology 1979; 77","author":"Heirwegh, K.P.M.","unstructured":"Heirwegh KPM. Bilirubin conjugates in bile of man Gastroenterology 1979; 77: 611-7."}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.21.8.650","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T20:36:05Z","timestamp":1765658165000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.21.8.650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1980,8]]},"references-count":22,"journal-issue":{"issue":"8","published-online":{"date-parts":[[1980,8,1]]},"published-print":{"date-parts":[[1980,8]]}},"alternative-id":["10.1136\/gut.21.8.650"],"URL":"https:\/\/doi.org\/10.1136\/gut.21.8.650","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1980,8]]}}}