Serum-Bile-Acid Levels in Liver Disease

Osborn, E. C.; Wootton, I. D. P.; Silva, L.C. Da; Sherlock, Sheila

doi:10.1016/s0140-6736(59)91527-2

Cited by 99 publications

(30 citation statements)

References 14 publications

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“…A reduction in the trihydroxy/dihydroxy bile salt ratio has been reported in lithogenic bile (Tamesue and Juniper, 1967) but there is little information about the bile salts in cirrhosis. Osborn, Wooton, da Silva, and Sherlock (1959) reported the ratio of these bile acids in the serum to be lower in portal cirrhosis but not in biliary cirrhosis. Sjovall (1960) found that although the deoxycholic acids were reduced in cirrhosis the cholic acid portion was also decreased so that chenodeoxycholic acid (a dihydroxy bile acid) comprised about two-thirds of the total bile acids in the bile.…”

Section: Discussionmentioning

confidence: 98%

Postmortem study of the frequency of gallstones in patients with cirrhosis of the liver

Bouchier¹

1969

Gut

189

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SUMMARY The frequency of gallstones in cirrhotic and non-cirrhotic patients at necropsy has been determined from a retrospective survey of postmortem records over 15 years. The frequency of gallstones was found to be 29.4% in the cirrhotic group and 12.8% in the non-cirrhotic population. Whereas gallstones were twice as frequent in females than males in the general population the sex difference disappeared in cirrhotic patients. Gallstones increased in frequency with age in the general population but this phenomenon was not seen in the cirrhotic group. No one type of cirrhosis was more liable to be associated with gallstones at necropsy. In contrast to the general population bilirubin stones were more frequent in cirrhotics.

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Section: Discussionmentioning

confidence: 98%

Postmortem study of the frequency of gallstones in patients with cirrhosis of the liver

Bouchier¹

1969

Gut

189

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“…Elucidation of the complicated chemical alterations involved in cholesterol degradation has suggested the possibility that analysis of BA in body fluids such as serum would aid in differential diagnosis of liver and biliary tract disorders. This approach has found only limited usefulness [2,3,15,17,19]. The possibilities are still being explored, however, because sensitive methods have become available recently for separation and measurement of the small amounts of BA normally present in human serum [2,19].…”

Section: Discussionmentioning

confidence: 99%

Bile Acid Concentrations in Serum during Infancy and Childhood

Sandberg

1970

Pediatr Res

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ExtractConcentrations of free and conjugated bile acids in cord blood (30 samples) were within the adult range and were significantly higher than in serum from newborns (15 infants). Deoxycholic acid (D) was absent from sera of newborns and present in 7 of 23 cord samples. Only two of nine infants in year 1 of life showed detectable amounts of D. In 25 children, ages 1-13 years, bile acid concentrations in serum fell within the normal adult range. Small amounts of unconjugated bile acids were present in some specimens.Thirty-three children with cystic fibrosis of the pancreas (ages 2-14 years) had serum concentrations within the normal adult range. No correlation with age, sex, or severity of disease was noted.Thirty-two children with a variety of hepatobiliary disorders had significantly elevated concentrations of bile acids with the exception of a few infants with terminal cirrhosis. Determination of patterns and concentrations of bile acids in serum are of limited usefulness in differential diagnosis of these disorders. Speculation

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“…Patients with liver disease have been shown to have elevated serum bile acids (Rudman and Kendall, 1957;Osborn, Wootton, Da Silva, and Sherlock, 1959), a reversal of the plasma trihydroxy to dihydroxy bile acid ratio (Carey, 1958), a decreased removal and conjugation of bile acids from the plasma (Blum and Theodor, Spritz, and Sleisenger, 1968), a diminished enterohepatic bile acid pool (Vlahcevic, Buhac, Farrar, Bell, and Swell, 1971), a marked reduction in cholic acid synthesis Vlahcevic, Juttijudata, Bell, and Swell, 1972), and a very low percentage of biliary deoxycholic acid (Vlahcevic et al, 1970). These abnormalities in bile acid metabolism can probably be attributed to a combination of parenchymal liver cell disease and the presence of portasystemic shunts.…”

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confidence: 99%

Cholic acid synthesis as an index of the severity of liver disease in man

McCormick¹,

Bell²,

Swell³

et al. 1973

Gut

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SUMMARY Bile acid pool size and kinetics were determined in 17 patients with cirrhosis and 11 patients without liver disease and correlated with the severity of liver disease as determined by the usual clinical and laboratory criteria. In order to assess the severity of liver disease, a grading system was devised which assigned numerical values to various clinical signs and laboratory results. The total clinical score and the patients were divided into two groups of advanced (7-18 points) or mild (1-6 points) cirrhosis. The clinical rating was then correlated with the various aspects of bile acid metabolism. Cholic acid synthesis was markedly reduced in the early stages of cirrhosis and continued to decrease with the advancement of the liver disease. There was an inverse correlation between synthesis of cholic acid and the severity of cirrhosis. Nine of the 10 patients with advanced cirrhosis and a very low cholic acid synthetic rate (average 68 mg per day) died within one to 13 months from the start of the study. Patients with mild cirrhosis also had significantly reduced cholic acid synthesis (average 152 mg per day) but they all were well and alive three to 23 months after the study. In contrast, chenodeoxycholic acid synthesis was not markedly affected in either patients with mild or advanced cirrhosis. There was also a high degree of correlation between the fractional daily turnover rate of cholic acid and the severity of liver disease. The fractional daily turnover rate of cholic acid was greatly reduced (50%) in patients with advanced cirrhosis. Deoxycholic acid was reduced in patients with mild cirrhosis and virtually absent from the bile of patients with advanced cirrhosis. The findings of the present report provide evidence that cholic acid synthesis is a sensitive indicator of the hepatocellular damage, whereas chenodeoxycholic acid synthesis is relatively unaffected by cirrhosis. The selective alteration in cholic acid synthesis probably resides in a deficiency of one or more enzymes regulating the formation of the 3-keto, 7 alpha, 12 alpha-dihydroxy precursor of cholic acid.

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Serum-Bile-Acid Levels in Liver Disease

Cited by 99 publications

References 14 publications

Postmortem study of the frequency of gallstones in patients with cirrhosis of the liver

Postmortem study of the frequency of gallstones in patients with cirrhosis of the liver

Bile Acid Concentrations in Serum during Infancy and Childhood

Cholic acid synthesis as an index of the severity of liver disease in man

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