Serum bile acids in the diagnosis of hepatobiliary disease

Abstract

The value of serum bile acids (SBA) in the diagnosis of hepatobiliary disease was investigated. A modified GLC method was used, with an overall coefficient of variation of ± 11% in the control range. Serum was obtained after a 12 hour fast, and two hours after a fatty meal from 73 patients and 14 control subjects. In controls the total fasting SBA of 2.17 ± 0.86 μmol/l increased significantly (P<0.001) to 3.81 ± 1.14 μmol/l after a meal. All icteric patients had raised SBA, but in 23 anicteric patients there was no significant difference in the detection of chronic liver disease by fasting SBA, postprandial SBA, AST, or γ GTP. Compared with controls, serum in patients contained proportionately less deoxycholic acid (P<0.001), there was proportionately more cholic acid in extrahepatic obstruction (P<0.001), and proportionately more chenodeoxycholic acid in patients with cirrhosis, viral hepatitis and neoplasia (P<0.001). In control subjects, the fasting cholic:chenodeoxycholic acid ratio ranged from 0.5-1.0, and differed significantly (P<0.001) from patients with extrahepatic obstruction 0.96-3.6, and cirrhosis 0.1-0.5. It is concluded that serum bile acids measured by sensitive methods can provide useful diagnostic information.