D-Glucaric Acid in Common Duct Bile and Relation to Choledocholithiasis

Background: The aim was to investigate a possible association between D-glucaric acid (DGA), biliary bilirubin glucuronidation and brown pigment stones in the common bile duct. Methods: A high performance liquid chromatography method with a strong cation resin (HPX-87H) was developed for measuring biliary DGA. Bile was obtained during ERCP by deep cannulation of the common bile duct in 100 patients with suspected biliary disease. Results: The concentration of DGA in common bile duct bile was 60 (1.1-633) μmol l -1 (median, range). The values were lower than previously reported. There were no differences in DGA concentrations in patients with common bile duct stones compared to patients without common bile duct stones, irrespective of stone type, cholesterol or brown pigment stones. Bilirubin conjugates in common duct bile did not vary with DGA concentrations. Conclusion: DGA is probably insignificant in the pathogenesis of common bile duct stones.