The Physico-chemical Defect

About 20 years ago, an era of major advances in clinical and basic research into gallstone pathogenesis began when the principles of physical chemistry were applied to cholesterol solubilisation and transport. The major (experimental) outcome was the reasonably accurate clinical definition of cholesterol saturation and supersaturation. Supersaturation, the indispensable prerequisite to cholesterol crystallisation and precipitation, was the first key discovery of this era of advances.