Cholestyramine loading test to assess hepatic reserve for bile acid synthesis in patients with chronic liver diseases.
OBJECTIVE
Serum 7alpha-hydroxycholesterol level reflects hepatic bile acid synthesis in humans. The aim of this study was to examine the maximal bile acid synthesis in patients with chronic liver diseases.


METHODS
Cholestyramine (12 g/day) was administered for 3 days to patients with compensated liver cirrhosis (n = 7), patients with chronic hepatitis (n = 10), and control subjects (n = 9), and serum total 7alpha-hydroxycholesterol level was measured by gas-liquid chromatography-mass spectrometry.


RESULTS
A preliminary study showed that cholestyramine increased the serum value to the maximum by the third day. Before cholestyramine treatment, there were no significant differences in serum 7alpha-hydroxycholesterol levels among the groups. Three days of cholestyramine treatment increased the serum levels 5.71 +/- 2.90-fold in the controls, 3.25 +/- 0.85-fold in patients with chronic hepatitis, and 1.70 +/- 0.78-fold in cirrhotic patients. Cirrhotic patients had significantly lower serum 7alpha-hydroxycholesterol levels after the treatment compared with other groups. Serum 7alpha-hydroxycholesterol levels stimulated by cholestyramine significantly correlated with serum albumin levels and indocyanine green retention rate.


CONCLUSIONS
Three days of cholestyramine loading increased the bile acid synthesis to its maximal level. The cholestyramine test showed that patients with chronic hepatitis had enough hepatic reserve for bile acid synthesis; however, patients with compensated liver cirrhosis had significantly decreased capacity.
Kuroki
S
S
Department of Surgery 1, Kyushu University Faculty of Medicine, Higashi-ku, Fukuoka, Japan.
Naito
T
T
Okamoto
S
S
Sakai
H
H
Yamashita
H
H
Chijiiwa
K
K
Tanaka
M
M
D000368:Aged; D001647:Bile Acids and Salts / Q000096:biosynthesis*; D002784:Cholesterol / Q000097:blood; D002792:Cholestyramine Resin; D004305:Dose-Response Relationship, Drug; D005260:Female; D006521:Hepatitis, Chronic / Q000378:metabolism*; D006801:Humans; D006888:Hydroxycholesterols / Q000097:blood*; D008099:Liver / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000032:analysis
D001647:Bile Acids and Salts; D006888:Hydroxycholesterols; D012709:Serum Albumin; D002792:Cholestyramine Resin; C011724:cholest-5-en-3 beta,7 alpha-diol; D002784:Cholesterol