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. 1977 Nov;18(11):903–908. doi: 10.1136/gut.18.11.903

Serum bile acids in the diagnosis of hepatobiliary disease.

C R Pennington, P E Ross, I A Bouchier
PMCID: PMC1411741  PMID: 590851

Abstract

The value of serum bile acids (SBA) in the diagnosis of hepatobiliary disease has been investigated. A modified GLC method was used, with an overall coefficient of variation of +/- 11% in the control range. Serum was obtained after a 12 hour fast, and two hours after a fatty meal from 73 patients and 14 control subjects. In controls the total fasting SBA of 2.17 +/- 0.86 mumol/l increased significantly (p less than 0.001) to 3.81 +/- 1.14 mumol/l after a meal. All icteric patients had raised SBA, but in 23 anicteric patients there was no significant difference in the detection of chronic liver disease by fasting SBA, postprandial SBA, AST, or gamma GTP. Compared with controls, serum in patients contained proportionately less deoxycholic acid (p less than 0.001), there was proportionately more cholic acid in extrahepatic obstruction (p less than 0.001), and proportionately more chenodeoxycholic acid in patients with cirrhosis, viral hepatitis, and neoplasia (p less than 0.001). In control subjects, the fasting cholic:chenodeoxycholic acid ratio ranged from 0.5-1.0, and differed significantly (p less than 0.001) from patients with extrahepatic obstruction 0.96-3.6, and cirrhosis 0.1-0.5. It is concluded that serum bile acids measured by sensitive methods can provide useful diagnostic information.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson K. E., Kok E., Javitt N. B. Bile acid synthesis in man: metabolism of 7 -hydroxycholesterol- 14 C and 26-hydroxycholesterol- 3 H. J Clin Invest. 1972 Jan;51(1):112–117. doi: 10.1172/JCI106780. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Angelin B., Einarsson K., Hellström K. Evidence for the absorption of bile acids in the proximal small intestine of normo- and hyperlipidaemic subjects. Gut. 1976 Jun;17(6):420–425. doi: 10.1136/gut.17.6.420. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barnes S., Gallo G. A., Trash D. B., Morris J. S. Diagnositic value of serum bile acid estimations in liver disease. J Clin Pathol. 1975 Jun;28(6):506–509. doi: 10.1136/jcp.28.6.506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bloomer J. R., Allen R. M., Klatskin G. Serum bile acids in primary biliary cirrhosis. Arch Intern Med. 1976 Jan;136(1):57–61. [PubMed] [Google Scholar]
  5. CAREY J. B., Jr The serum trihydroxy-dihydroxy bile acid ratio in liver and biliary tract disease. J Clin Invest. 1958 Nov;37(11):1494–1503. doi: 10.1172/JCI103741. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cronholm T., Norman A., Sjövall J. Bile acids and steroid sulphates in serum of patients with infectious hepatitis. Scand J Gastroenterol. 1970;5(4):297–303. [PubMed] [Google Scholar]
  7. Fausa O., Gjone E. Serum bile acid concentrations in patients with liver disease. Scand J Gastroenterol. 1976;11(5):537–543. [PubMed] [Google Scholar]
  8. Fausa O. Quantitative determination of serum bile acids using a purified 3 alpha-hydroxysteroid dehydrogenase. Scand J Gastroenterol. 1975;10(7):747–752. [PubMed] [Google Scholar]
  9. Fausa O. Serum bile acid concentration after a test meal. Scand J Gastroenterol. 1976;11(3):229–232. [PubMed] [Google Scholar]
  10. Greim H., Trülzsch D., Czygan P., Rudick J., Hutterer F., Schaffner F., Popper H. Mechanism of cholestasis. 6. Bile acids in human livers with or without biliary obstruction. Gastroenterology. 1972 Nov;63(5):846–850. [PubMed] [Google Scholar]
  11. Javitt N. B., Morrissey K. P., Siegel E., Goldberg H., Gartner L. M., Hollander M., Kok E. Cholestatic syndromes in infancy: diagnostic value of serum bile acid pattern and cholestyramine administration. Pediatr Res. 1973 Mar;7(3):119–125. doi: 10.1203/00006450-197303000-00003. [DOI] [PubMed] [Google Scholar]
  12. Kaplowitz N., Kok E., Javitt N. B. Postprandial serum bile acid for the detection of hepatobiliary disease. JAMA. 1973 Jul 16;225(3):292–293. [PubMed] [Google Scholar]
  13. Knodell R. G., Kinsey M., Boedeker E. C., Collin D. P. Deoxycholate metabolism in alcoholic cirrhosis. Gastroenterology. 1976 Aug;71(2):196–201. [PubMed] [Google Scholar]
  14. Makino I., Hashimoto H., Shinozaki K., Yoshino K., Nakagawa S. Sulfated and nonsulfated bile acids in urine, serum, and bile of patients with hepatobiliary diseases. Gastroenterology. 1975 Mar;68(3):545–553. [PubMed] [Google Scholar]
  15. Makino I., Nakagawa S., Mashimo K. Conjugated and unconjugated serum bile acid levels n patients with hepatobiliary diseases. Gastroenterology. 1969 Jun;56(6):1033–1039. [PubMed] [Google Scholar]
  16. McCormick W. C., 3rd, Bell C. C., Jr, Swell L., Vlahcevic Z. R. Cholic acid synthesis as an index of the severity of liver disease in man. Gut. 1973 Nov;14(11):895–902. doi: 10.1136/gut.14.11.895. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Mitropoulos K. A., Myant N. B. The formation of lithocholic acid, chenodeoxycholic acid and alpha- and beta-muricholic acids from cholesterol incubated with rat-liver mitochondria. Biochem J. 1967 May;103(2):472–479. doi: 10.1042/bj1030472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Murphy G. M., Billing B. H., Baron D. N. A fluorimetric and enzymatic method for the estimation of serum total bile acids. J Clin Pathol. 1970 Oct;23(7):594–598. doi: 10.1136/jcp.23.7.594. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Neale G., Lewis B., Weaver V., Panveliwalla D. Serum bile acids in liver disease. Gut. 1971 Feb;12(2):145–152. doi: 10.1136/gut.12.2.145. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Palmer R. H. The formation of bile acid sulfates: a new pathway of bile acid metabolism in humans. Proc Natl Acad Sci U S A. 1967 Sep;58(3):1047–1050. doi: 10.1073/pnas.58.3.1047. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. RUDMAN D., KENDALL F. E. Bile acid content of human serum. I. Serum bile acids in patients with hepatic disease. J Clin Invest. 1957 Apr;36(4):530–537. doi: 10.1172/JCI103450. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Roovers J., Evrard E., Vanderhaeghe H. An improved method for measuring human blood bile acids. Clin Chim Acta. 1968 Mar;19(3):449–457. doi: 10.1016/0009-8981(68)90272-6. [DOI] [PubMed] [Google Scholar]
  23. Ross P. E., Pennington C. R., Bouchier I. A. Gas-liquid chromatographic assay of serum bile acids. Anal Biochem. 1977 Jun;80(2):458–465. doi: 10.1016/0003-2697(77)90668-6. [DOI] [PubMed] [Google Scholar]
  24. Stiehl A. Bile salt sulphates in cholestasis. Eur J Clin Invest. 1974 Feb;4(1):59–63. doi: 10.1111/j.1365-2362.1974.tb00373.x. [DOI] [PubMed] [Google Scholar]
  25. Van Berge Henegouwen G. P., Ruben A., Brandt K. H. Quantitative analysis of bile acids in serum and bile, using gas--liquid chromatography. Clin Chim Acta. 1974 Aug 20;54(3):249–261. doi: 10.1016/0009-8981(74)90243-5. [DOI] [PubMed] [Google Scholar]
  26. Yoshida T., McCormick W. C., 3rd, Swell L., Vlahcevic Z. R. Bile acid metabolism in cirrhosis. IV. Characterization of the abnormality in deoxycholic acid metabolism. Gastroenterology. 1975 Feb;68(2):335–341. [PubMed] [Google Scholar]

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