2018
DOI: 10.1097/mpg.0000000000002037
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Total Bile Acid Concentration in Duodenal Fluid Is a Useful Preoperative Screening Marker to Rule Out Biliary Atresia

Abstract: DTT evaluated by dTBA, dTBA/sTBA ratio, and dTBA/sGGT ratio had high accuracy to rule out BA and could avoid unnecessary surgery in some infants.

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Cited by 9 publications
(4 citation statements)
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“…Median serum FGF19 levels were remarkably similar in both these BA studies, whereas unlike here, likely administered UDCA, with FXR antagonist activity 29 , 41 was the most predominant serum bile acid in the study by Johansson et al, potentially contributing to the missing correlation between bile acids and FGF19 in their study. 19 Although biliary secretion of bile acids into the intestine is negligible at the time of KPE because of widespread destruction of the extrahepatic bile ducts, 34 bile acids reach enterocytes also through systemic circulation. Theoretically, it remains possible that after escaping from the liver into the systemic circulation in high concentrations, 22 , 39 bile acids may also activate intestinal FXR-FGF19 from the basolateral side of enterocytes, 42 thereby contributing to the increased FGF19 serum levels.…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…Median serum FGF19 levels were remarkably similar in both these BA studies, whereas unlike here, likely administered UDCA, with FXR antagonist activity 29 , 41 was the most predominant serum bile acid in the study by Johansson et al, potentially contributing to the missing correlation between bile acids and FGF19 in their study. 19 Although biliary secretion of bile acids into the intestine is negligible at the time of KPE because of widespread destruction of the extrahepatic bile ducts, 34 bile acids reach enterocytes also through systemic circulation. Theoretically, it remains possible that after escaping from the liver into the systemic circulation in high concentrations, 22 , 39 bile acids may also activate intestinal FXR-FGF19 from the basolateral side of enterocytes, 42 thereby contributing to the increased FGF19 serum levels.…”
Section: Discussionmentioning
confidence: 99%
“…In primary biliary cholangitis and alcoholic hepatitis high serum FGF19 levels associate with disease severity 28–30. Recent studies involving small number of BA patients indicate that liver expression and serum levels of FGF19 are increased both at the time of KPE and LT despite the diminished ileal exposure to luminal bile acids because of the severe cholestasis 19,20,34. Induction of FGF19 may thus represent another adaptative mechanism to cholestasis and therefore may be associated with postsurgical outcomes in BA.…”
Section: Introductionmentioning
confidence: 99%
“…Serum TBAs are typically low to normal in cholestasis due to bile acid synthesis disorders 55 . Duodenal biliary TBA (dTBA), dTBA/sTBA ratio, and dTBA/ serum GGT ratio were lower in infants with biliary atresia than healthy infants 56 . Bile acids have not been shown to correlate with the severity of pruritis in childhood cholestatic disorders 57 .…”
Section: Pediatric Cholestatic Disordersmentioning
confidence: 90%
“…Less invasive tests assessing patency which can be performed before IOC include the hepatobiliary iminodiacetic acid (HIDA) scan (follows a tracer from liver to intestine), endoscopic retrograde cholangiopancreatography (ERCP) (injects dye into the ampulla of Vater via endoscopy), and the percutaneous cholangiogram (PTC) (injects dye into the gall bladder via a percutaneous approach). Patency can also be assessed indirectly by measuring bilirubin or bile acids in the intestine (duodenal aspirates), with presence of bilirubin or bile acids inconsistent with BA (40). A normal HIDA scan, ERCP, PTC, or duodenal aspirate can exclude BA and make an IOC unnecessary.…”
Section: Diagnosismentioning
confidence: 99%