Bile Acid Levels in Diagnosing Mild Liver Disease

Abstract

In ten healthy controls and in ten patients with biopsy-proved mild liver disease, we studied fasting and postcholecystokinetic bile acid levels to assess their diagnostic value compared with standard liver tests. Cholecystokinetic bile acid elevation was standardized by evacuating the gallbladder with intramuscular ceruletide diethylamine (cholecystokinin decapeptide) in a double-blind, randomized, placebo-controlled crossover design. Radioimmunoassay of primary conjugated bile acids was adequately sensitive to separate controls from patients even on the basis of fasting serum bile acid levels. In both controls and patients, the 180-minute postcholecystokinetic bile acid time curve was significantly higher after ceruletide than after placebo. Nevertheless, neither this response nor any of the 30-minute postcholecystokinetic interval bile acid levels separated controls from patients better than the fasting bile acid values, which discriminated better than standard liver tests or the indocyanine green clearance at 20 minutes. Alanine aminotransferase separated the two groups with a sensitivity equal to fasting bile acid levels.