The effect of bile on the crystallisation of calcium carbonate, a constituent of gallstones.

When calcium and bicarbonate ions were mixed at room temperature (approximately 20 degrees C) to give concentrations of 4 mmol/1 and 21 mmol/1 respectively and the pH of the solution was kept at 8.3, vaterite, a form of calcium carbonate, was precipitated almost immediately as spheres of diameter 45 micron. The crystallisation of this material could be slowed down by adding to the crystallising medium small amounts of pyrophosphate or citrate which often inhibit crystal growth. High concentrations of sodium chloride (90 mmol/1) did not, however, affect the reaction. Very small amounts of gallbladder bile from patients with only cholesterol on the surface of their gallstones inhibited the crystallisation of calcium carbonate, and the size of the spheres was only 0.37 times those produced in water. The activity of the bile could be attributed to material with a molecular weight greater than 10 000. On the other hand, bile from patients having some calcium carbonate on the gallstone surface had less activity than comparable amounts of bile from patients with only cholesterol in this area. The active material may, therefore, play a part in preventing the deposition of calcium carbonate in gallstones.