The effect of coeliac disease upon bile salts

Abstract

SUMMARY The size and composition ofthe bile salt pool has been measured in patients with untreated coeliac disease and in control subjects. The total bile salt pool was markedly increased in coeliac patients, the average being 9.2 grams compared with 3.1 grams in controls. Taurocholate synthesis was normal, consistent with its enlarged pool and prolonged half-life. Half-life and pool size were significantly correlated. The composition of the bile salt pool was virtually identical in the two groups. Our findings suggest that as the enterohepatic circulation is slowed by gallbladder inertia, so hepatic surveillance of pool size is diminished.We have recently shown that in patients with untreated coeliac disease the gallbladder is relatively inert and the enterohepatic circulation of bile salts more sluggish than normal (Low-Beer, Heaton, Heaton, and Read, 1971). We attributed this to a failure of the damaged upper small intestinal mucosa to release cholecystokinin. This paper is concerned with the effect of the disease on the size of the bile salt pool, its composition, and its daily rate of turnover. Subjects and MethodsPatients with adult coeliac disease, in whom jejunal biopsy showed subtotal villous atrophy, and who were taking an unrestricted diet, volunteered to undertake these studies; they were compared with a group of age-matched volunteers with no history of gastrointestinal disease drawn from members of staff, hospital outpatients, and medical students. All analyses were performed on bile aspirated after an overnight fast through a tube in the duodenum. Bile flow was stimulated by an iv injection of 10-40 Ivy dog units of cholecystokinin. (Bruusgaard, 1970). The specificity of the salicylaldehyde method for measuring deoxycholic acid is shown in figure 1. In this experiment, the effect of increasing amounts of chenodeoxycholic acid on the absorbance at 700 ,u due to fixed amounts of glycodeoxycholic acid was measured. Chenodeoxycholic acid produced 3 % of the absorbance compared with equimolar amounts of glyco-PM

The effect of cholecystectomy on bile salt metabolism

“…The present investigation complements a similar one from this laboratory of patients with coeliac disease (Low-Beer, Heaton, Heaton, and Read, 1971;Low-Beer et al, 1973). In that study, exaggeration of the storage function of the gallbladder was noted and this was associated with changes in bile salt metabolism exactly opposite to those found after cholecystectomy, namely, slow turnover and diminished bacterial degradation of an enlarged bile salt pool.…”

“…Any unusual metabolites such as 7-ketodeoxycholate would have been detected as extra peaks by this technique. The relative proportions of the three main bile salts-cholate, chenodeoxycholate, and deoxycholate-were measured in each sample of bile by minor modifications of the method of Bruusgaard (1970) as described by Low-Beer, Heaton, Pomare, and Read (1973). The glycine to taurine conjugation ratio (G/T ratio) was calculated after measuring the total glycine and total taurine conjugates enzymatically.…”

Biliary lipids, bile acids, and gallbladder function in the human female. Effects of pregnancy and the ovulatory cycle.

“…Other studies provide support for a similar relationship between gallbladder volume and bile acid pool size in patients with celiac-sprue (57,58) and in man and dog after truncal vagotomy (55,59). Gallbladder volume increases, emptying after meals slows and the bile acid pool increases.…”

The Selective Inhibition of Chenodeoxycholate Synthesis by Cholate Metabolites in Man

“…The relative proportions of the three main bile salts, C, CDC and DC, were measured with the 3a-hydroxysteroid dehydrogenase enzyme used to assay cholate and combined DC and CDC, and the salicylaldehyde reaction used to assay DC in the presence of CDC (Bruusgaard, 1970;Low-Beer, Heaton, Pomare & Read, 1973). The average composition of the samples obtained in anyone turnover study was calculated, and this information was used to calculate total bile salt pool size from the size of the pools of C and CDC.…”