DIRECT ASSESSMENT OF THE MECHANISM FOR A RAISED SERUM BILE-ACID LEVELIN CHRONIC LIVER-DISEASE

Citation
Js. Decaestecker et al., DIRECT ASSESSMENT OF THE MECHANISM FOR A RAISED SERUM BILE-ACID LEVELIN CHRONIC LIVER-DISEASE, European journal of gastroenterology & hepatology, 7(10), 1995, pp. 955-961
Citations number
NO
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Gastroenterology & Hepatology
ISSN journal
0954-691X
Volume
7
Issue
10
Year of publication
1995
Pages
955 - 961
Database
ISI
SICI code
0954-691X(1995)7:10<955:DAOTMF>2.0.ZU;2-0
Abstract
Background: Impaired hepatic uptake is the major cause of raised serum bile acid levels in liver disease, but confirmation in humans by dire ct measurement is tacking. The synthetic gamma-labelled bile acid Se-7 5-homocholic acid taurine ((75)SeHCAT) provides a tool for the direct measurement of hepatic bile acid handling. Objective: To determine the interrelationships among hepatic handling of (75)SeHCAT, the kinetics of its disappearance from plasma and serum bile acid levels in patien ts with chronic liver disease. Design: We studied 12 patients with pri mary biliary cirrhosis and 14 with cirrhosis arising from other causes . Fasting serum bile acid levels were measured enzymatically. After in travenous administration of (75)SeHCAT, we determined plasma disappear ance rates (initial K-1, tate K-2) from serial blood samples and hepat ic uptake and excretory rates directly from dynamic abdominal gamma-ca mera scanning. Both scanning and sampling were carried out over a peri od of 90 min. Results: Serum bile acid concentrations correlated with K1 and with hepatic uptake (R(S) = -0.53, P < 0.01; R(S) = -0.47, P < 0.02, respectively) but neither with K-2 nor with the excretory rate. K1 and uptake were reduced (P < 0.05) in patients with high serum bile acid levels and in those with varices. Serum bile acid levels were hi gher in patients with varices (P < 0.05), which might suggest that por tosystemic shunting occurred. However, this is unlikely because the va rices were not independent of liver function. Conclusion: Hepatic bile acid uptake and excretion are independent processes. Hepatic uptake i s related to initial, whereas hepatic excretion is related to late, pl asma disappearance. Impaired hepatic uptake is a major determinant of the rise in serum bile acid levels in chronic liver disease.