Fasting Total Serum Bile Acid Research Articles

Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy.

Our objective was to evaluate in our clinic the perinatal outcomes of patients diagnosed with ICP based on pre-treatment maternal serum bile acid levels, attempt to identify the risk group and review the literature in light of this information. In total, 370 patients diagnosed with ICP were included in the study, divided into two groups based on the fasting total serum bile acid level before UDCA (Group 1: 10 ≥ 40 μmol/L, and Group 2: ≥ 40 μmol/L). The groups were examined for clinical characteristics and pregnancy outcomes. It was found that preterm delivery and neonatal intensive care need increased at a serum bile acid cut-off value of 34 μmol/L. Regardless of serum bile acid, significantly higher rates of meconium-stained amniotic fluid and foetal distress were observed in patients whose diagnoses were made before 34 weeks of gestation. Foetal complications over 40 μmol/L of serum bile acid were significantly increased. However, slightly lower levels cut-off values (34 μmol/L) were obtained in terms of preterm birth and neonatal intensive care need. The incidence of meconium-stained amniotic fluid and foetal distress was higher in patients whose diagnosis were made before 34 weeks of gestation.

Improvement of Glucose Metabolism Following Long-Term Taurocholic Acid Gavage in a Diabetic Rat Model.

BackgroundBile acids (BAs) are signaling molecules that participate in maintaining glucose homeostasis. Acute enteral infusion of BAs potently reduces the glycemic response to glucose, associated with an increase of incretin hormones. However, the effect of long-term supplementation of BAs on glucose metabolism has not been fully investigated.Material/MethodsThirty diabetic rats were assigned to a control group (n=10), a low TCA group (L-TCA group, n=10), and a high TCA group (H-TCA group, n=10). Rats in the control group were fed a regular high-fat diet (HFD), while rats in the L-TCA group and H-TCA group were fed a TCA (taurocholic acid)-mixed HFD with the concentrations of 0.05% and 0.3%, respectively, to control the intake of HFD and TCA. Energy intake, body weight, serum insulin, glucose tolerance, insulin sensitivity, GLP-1, and total serum BAs were measured at week 2 and week 12.ResultsAt week 2 there were no significant differences in body weight, daily energy intake, glucose tolerance, serum insulin, insulin sensitivity, GLP-1, or fasting total serum BAs between the 3 groups. At week 12, fasting blood glucose and intragastric glucose tolerance were better in the H-TCA group, with significantly greater insulin and GLP-1 secretion and better insulin sensitivity; no significant differences in body weight, energy intake, or total fasting serum BAs were observed.ConclusionsLong-term supplementation with small doses of TCA was demonstrated to improve glucose metabolism in a diabetic rat model and may be a potential target for diabetes control.

Conjugated Bile Acids Associate with Altered Rates of Glucose and Lipid Oxidation after Roux-en-Y Gastric Bypass

Laparoscopic Roux-en-Y gastric bypass (RYGB) induces a more favorable metabolic profile than expected by weight loss alone. In this study, we investigated the effect of RYGB on serum bile acid levels and their relation to clinical outcomes. We included 30 obese patients who underwent RYGB (BMI = 46.1 ± 5.9 kg/m(2)). Clinical measurements and laboratory determinations were performed before surgery and 1 year after surgery. Fasting serum bile acids were measured by an enzymatic method and individual bile acids were quantified by HLPC-tandem mass spectrometry. Indirect calorimetry was performed to measure the rates of energy expenditure and substrate oxidation. Fasting total serum bile acid levels increased twofold after RYGB (pre, 3.68 ± 2.03 vs. post, 7.06 ± 9.65 μmol/l, +92 %, p = 0.002). This increase in total bile acids was accompanied by a decrease in conjugated bile acids, which correlated with decreased glucose oxidation (r = 0.571, p = 0.002) and with increased lipid oxidation (r = -0.626, p = 0.0004). The change in taurine-conjugated bile acids correlated with altered DIO2 mRNA expression in adipose tissue (r = -0.498, p = 0.013) potentially linking bile acid conjugation to substrate oxidation through DIO2. Fasting serum bile acid levels increase after RYGB. More specifically, changes in bile acid conjugation after RYGB associate with altered energy metabolism.

Sex hormones and bile acids in intrahepatic cholestasis of pregnancy

Sex hormones and bile acids in intrahepatic cholestasis of pregnancy

Clinical Application of Serum Bile Acid Measurement·

The diagnostic usefulness of fasting total serum bile acids (SBA) in assessment of hepatic function alterations were evaluated in 30 healthy subjects and 57 patients with obstructive jaundice. The values of SBA were compared with standard liver function tests. SBA can be used as an additional liver function test.

Treatment of pruritus in primary biliary cirrhosis with rifampin: Results of a double-blind, crossover, randomized trial

The cause of pruritus of cholestasis is unknown. We have hypothesized that pruritus may be caused by an indirect effect of high hepatic concentrations of toxic bile acids. To test this hypothesis, we have conducted a double-blind, controlled, crossover clinical trial of rifampin, an agent that inhibits hepatic bile acid uptake and may detoxify hepatic bile acids by stimulation of mixed-function oxidases. Nine patients with primary biliary cirrhosis received 300–450 mg/day of rifampin and placebo sequentially, in random order. Each treatment was administered for 14 days, with a 14-day washout between treatments. Endpoints included patient preference, changes in a daily visual analogue scale pruritus score, and amount of cholestyramine ingested. Antipyrine elimination rates and serum bile acids were tested at the end of each treatment period. All 9 patients completed the trial and 8 of them preferred rifampin to placebo (p = 0.03). There were no adverse reactions. Visual analogue scale pruritus scores showed no significant placebo response or any effect from the order of treatment, but did show a highly significant reduction in pruritus in response to rifampin (p < 0.002). This effect was evident within the first week of rifampin treatment. Rifampin produced a 33% reduction in antipyrine plasma half-life, but no change in fasting total serum bile acids. Cholestyramine usage did not change significantly. We conclude that rifampin is useful for short-term relief of pruritus in primary biliary cirrhosis; however, the mechanism of this effect is unknown. Longer trials are needed, as are trials in other cholestatic disorders.

Kinetics of 14C-glycocholic acid clearance in normal man and in patients with liver disease.

The plasma clearance of a tracer dose of 14C-glycocholic acid, and fasting total serum bile acid concentrations were measured in 14 control subjects and in 38 patients with acute and chronic liver disease. In controls plasma clearance was 415 +/- 24 ml min-1 m-2 (mean +/- SEM), equivalent to a 'first-pass' extraction by the liver of 85%. Clearance was not significantly different from controls in patients with acute hepatitis or active chronic hepatitis, nor in anicteric patients with primary biliary or alcoholic cirrhosis. Thus bile acid clearance was impaired only in icteric chronic liver disease. In contrast, serum bile acid concentrations were abnormal in all but seven patients, six of whom had active chronic hepatitis in complete biochemical remission. The pattern of plasma disappearance of injected 14C-glycocholic acid was biexponential in controls and patients with liver disease, and computer analysis of the curves suggested that there was significant distribution of bile acid outside the vascular space. The preservation of bile acid clearance in anicteric chronic liver disease confirms that it is dependent more on liver blood flow than on liver cell function.