A Cholecystohepatic Shunt Pathway: Does the Gallbladder Protect the Liver?  James L. Boyer, Carol J. Soroka  Gastroenterology  Volume 142, Issue 7, Pages 1416-1419 (June 2012) DOI: 10.1053/j.gastro.2012.04.036 Copyright © 2012 AGA Institute Terms and Conditions

Figure 1 Cholecystohepatic shunt in Cftr−/− mice. The absence of Cftr in the intestine (1) leads to the acidification of the intestinal lumen (2), which stimulates the production of the myorelaxant, vasointestinal peptide (3). Vasointestinal peptide circulates to the gallbladder (red line), resulting in delayed emptying of the gallbladder and, thus, reduced delivery of bile acids (Δ) to the duodenum (dotted green line) (4). This provides less bile acids for bacterial dehydroxylation to secondary bile acids (Δ), resulting in a more hydrophilic bile acid pool (5). In the ileum the decrease in intestinal bile acids down-regulates Asbt, Ostα-Ostβ, Fgf15, Shp, and Ibabp mRNA (6) and reduces the return of bile acids in the enterohepatic circulation (dotted green line) (7). In contrast, the more prolonged retention of bile acids in the gallbladder up-regulates Asbt, Ostα-Ostβ, and Fgf15 mRNA (8) and leads to an increased shunting of primary bile acids directly back to the liver (solid green line) (9). Gastroenterology 2012 142, 1416-1419DOI: (10.1053/j.gastro.2012.04.036) Copyright © 2012 AGA Institute Terms and Conditions