Cholesterol Nucleation and Growth in Gallstone Formation

Abstract

Cholesterol gallstones are composed of crystalline cholesterol monohydrate and are formed from cholesterol dissolved in bile; thus, cholesterol monohydrate crystallization is a prerequisite for cholesterol-gallstone formation. This relation has been documented in the past and is further substantiated by Sedaghat and Grundy in this issue of the Journal. There are five stages in the formation of symptomatic cholesterol-gallstone disease,^{1 , 2} and each is a prerequisite for the next. At first there is a genetic and metabolic stage, in which the genetic propensity or metabolic abnormality that can lead to production of supersaturated bile is present but not yet manifest. Secondly, . . .