Metabolic basis of cholesterol gallstone disease.

Our understanding of the fundamental processes that control cholesterol and bile salt homeostasis is expanding rapidly; however, there are still large gaps in our knowledge, particularly regarding the mechanism of bile formation and the control of biliary lipid secretion. Defects in bile salt secretion, differences in the relative proportion of various bile salts, and an increased rate of cholesterol secretion have all been found to lead to the formation of lithogenic bile. As our understanding of these processes increases, better strategies for the prevention and treatment of gallstones will emerge.