Ileal absorption of bile acids in patients with chronic cholestasis: SeHCAT test results and effect of ursodeoxycholic acid (UDCA).
The effect of cholestasis on ileal bile acid absorption is controversial in animal models (up- or down-regulation) and unknown in humans. We therefore studied values of the selena homotaurocholic acid (SeHCAT) test before and after long-term administration (>3 months, 13-15 mg/kg/day) of ursodeoxycholic acid (UDCA) in 27 patients with chronic cholestatic liver diseases (24 women, 3 men; mean age, 50 years; 24 primary biliary cirrhosis, 2 secondary biliary cirrhosis, 2 others). The control group consisted of 14 healthy volunteers. Seven-day SeHCAT percentage retention was identical in the 12 untreated cholestatic patients (serum bilirubin, 75+/-42 micromol/L, alkaline phosphatase, 4.2+/-1.0 N; mean+/-SEM) and in the control group (43.6+/-2.9 and 43.8+/-4.2%, respectively). In the 22 patients treated by UDCA for 38+/-8 months, SeHCAT percentage retention was 20.3+/-3.0%. In the seven patients with the SeHCAT test done before and after UDCA treatment (16+/-5 months), SeHCAT percentage retention decreased significantly under UDCA therapy (42.0+/-4.4 vs 19.4+/-4.1%; P < 0.02). We conclude that, in patients with chronic cholestasis (1) SeHCAT percentage retention is not altered-taken together with the known defect of biliary excretion, this lack of increase in SeHCAT percentage retention argues against up-regulation of bile acid ileal transport; and (2) UDCA treatment induces a decrease in the SeHCAT percentage retention-this effect may be related primarily to a decreased bile acid ileal absorption.
Chazouillères
O
O
Unité d'Hépatologie, Hôpital Saint-Antoine, Paris, France.
Marteau
P
P
Haniche
M
M
Jian
R
R
Poupon
R
R
D000469:Alkaline Phosphatase / Q000378:metabolism; D001647:Bile Acids and Salts / Q000378:metabolism*; D002779:Cholestasis / Q000150:complications / Q000188:drug therapy / Q000378:metabolism*; D002908:Chronic Disease; D015536:Down-Regulation; D005260:Female; D006801:Humans; D007082:Ileum / Q000378:metabolism*; D007408:Intestinal Absorption; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D012644:Selenium Radioisotopes / Q000097:blood*; D013656:Taurocholic Acid / Q000031:analogs & derivatives* / Q000097:blood; D015854:Up-Regulation; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*; D005723:gamma-Glutamyltransferase / Q000378:metabolism
D001647:Bile Acids and Salts; D012644:Selenium Radioisotopes; D013656:Taurocholic Acid; D014580:Ursodeoxycholic Acid; C033638:23-seleno-25-homotaurocholic acid; D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase