Decreased bile acid synthesis with total parenteral nutrition.
BACKGROUND
Biliary changes occur in patients on total parenteral nutrition (TPN) predisposing them to gallstones and cholestasis. We hypothesized that patients on TPN, similar to animal models, would have reduced bile acid synthesis.


METHODS
Serum from 13 controls and 17 patients on TPN were collected and tested with HPLC for 7alpha-hydroxy-4-cholesten-3-one, which has been shown to correlate with bile acid synthesis. Somatostatin and tumor necrosis factor alpha levels were determined with enzyme-linked immunosorbent assays.


RESULTS
Bile acid synthesis was significantly reduced in patients on TPN. TPN patients on oral feeding (but not jejunostomy) had similar bile acid synthesis rates as controls. In patients on TPN and nothing by mouth, somatostatin had a significant negative correlation with bile acid synthesis (P < .01).


CONCLUSIONS
TPN patients have a reduced bile acid synthesis, and this correlates with somatostatin if they are treated with nothing by mouth. Oral feeding is associated with a higher bile acid synthesis, and body mass index, age, albumin, and tumor necrosis factor alpha do not have an effect on bile acid synthesis.
Dawes
Lillian G
LG
Department of Surgery, Ann Arbor VA Medical Center and the University of Michigan, 2215 Fuller (112) Ann Arbor, MI 48105, USA. ldawes@umich.edu
Laut
Harrison C
HC
Woodruff
Marilyn
M
D000368:Aged; D001647:Bile Acids and Salts / Q000096:biosynthesis*; D001660:Biliary Tract Diseases / Q000209:etiology; D002783:Cholestenones / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D013004:Somatostatin / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D001647:Bile Acids and Salts; D002783:Cholestenones; D014409:Tumor Necrosis Factor-alpha; C002656:7 alpha-hydroxy-4-cholesten-3-one; D013004:Somatostatin