title: Liquid chromatography-mass spectroscopy as a tool in the rapid diagnosis of biliary atresia: a pilot study.
abstract: BACKGROUND
  Biliary atresia (BA) is a neonatal obstructive cholangiopathy requiring rapid intervention to prevent end-stage liver failure and death. Low bile acid levels in stool, detectable with high-performance liquid chromatography-mass spectroscopy, may reflect extrahepatic biliary obstruction in cholestasis.
  
  
  OBJECTIVE
  Stool bile acid content can differentiate BA from non-BA forms of cholestasis.
  
  
  METHODS
  Stool samples from four healthy and nine cholestatic patients were collected following internal review board approval. Bile acids were extracted and separated on a 4000-Q-Trap HPLC-MS system.
  
  
  RESULTS
  Total bile acid content was highest in samples from healthy relative to cholestatic patients: 3354.01 ± 2102.56, 1476.27 ± 1361.07, and 34.29 ± 10.30 μM/mg of stool in healthy, total parenteral nutrition-associated cholestasis, and BA samples, respectively. Mean cholic acid and chenodeoxycholic acid concentrations in healthy samples (2017.5 ± 1413.6 and 876.83 ± 660.60 μM/mg) were higher than in TPN cholestatic samples (93.99±131.55 and 232.34 ± 293.41 μM/mg). The most dramatic reduction in cholic acid and chenodeoxycholic acid was observed in BA samples (0.65 ± 0.47 and 1.22 ± 0.80 μM/mg).
  
  
  CONCLUSIONS
  Bile acid content in stool is reduced in cholestatic patients relative to healthy patients with the most dramatic reduction observed in BA-patients.
authors.affiliation: Children's Hospital Los Angeles.
authors.forename: Marie
authors.initials: M
authors.lastname: Nguyen
authors.affiliation: Children's Hospital Los Angeles.
authors.forename: Avafia
authors.initials: A
authors.lastname: Dossa
authors.affiliation: Children's Hospital Los Angeles.
authors.forename: Jessica
authors.initials: J
authors.lastname: Zagory
authors.affiliation: Children's Hospital Los Angeles.
authors.forename: Jamie
authors.initials: J
authors.lastname: Golden
authors.affiliation: Children's Hospital Los Angeles.
authors.forename: Anne
authors.initials: A
authors.lastname: Roberts
authors.affiliation: Children's Hospital Los Angeles.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Fu
authors.affiliation: Children's Hospital Los Angeles.
authors.forename: Kasper
authors.initials: K
authors.lastname: Wang
authors.affiliation: Children's Hospital Los Angeles. Electronic address: cgayer@chla.usc.edu.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Gayer
mesh_terms: D001647:Bile Acids and Salts / Q000378:metabolism*; D001656:Biliary Atresia / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D002851:Chromatography, High Pressure Liquid; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013058:Mass Spectrometry; D010865:Pilot Projects; D011446:Prospective Studies
chemical_list: D001647:Bile Acids and Salts; D015415:Biomarkers
keywords: Bile acids; Biliary atresia; HPLC