deoxycholic-acid and Esophageal-and-Gastric-Varices

The purpose of this study was to compare the endoscopic findings based on the general rules for recording endoscopic findings on esophageal varices by the Japanese Research Society for Portal Hypertension with liver function tests including serum bile acids and bile acid clearance tests in 64 patients with liver cirrhosis. Cases of esophageal varices showed significantly higher serum bile acid levels and greater ICG retention than those without esophageal varices. The oral ursodeoxycholic acid tolerance test was significantly impaired in the group with esophageal varices (p less than 0.05). In cases with esophageal varices, there was no significant difference in serum bile acid levels between white and blue varix patients, while serum bile acid levels in the red-color sign-positive group were significantly higher than those in the negative group (p less than 0.01). Serum bile acid levels increased in parallel with the form of varices as reflected by the shape and size of varices and with the location of varices which reflects the longitudinal-extent of varices. These results indicate that the impaired clearance of serum bile acids in liver cirrhosis is closely related with the red-color sign on the variceal surface and with the form and location of esophageal varices, which may reflect the grade of portal-systemic shunting.

Topics: Adult; Aged; Bile Acids and Salts; Deoxycholic Acid; Esophageal and Gastric Varices; Esophagoscopy; Female; Humans; Liver Cirrhosis; Liver Function Tests; Male; Middle Aged; Ursodeoxycholic Acid

The urinary and fecal bile acids of thirteen male patients with liver cirrhosis were analyzed by gas chromatography and gas chromatography-mass spectrometry to obtain information on their keto bile acid excretion. 3 alpha-Hydroxy-12-keto-5 beta-cholanoic, 3 alpha,12 alpha-dihydroxy-7-keto-5 beta-cholanoic, 3 alpha,7 alpha-dihydroxy-12-keto-5 beta-cholanoic and 3 alpha-hydroxy-7,12-diketo-5 beta-cholanoic acids were found in the urine of ten patients. In four of these patients, keto bile acids were the main bile acids excreted in the urine. However, the ratios of fecal keto bile acids to the total fecal bile acids in these four patients were similar to those in the other six patients whose urinary excretion of keto bile acids was low. Three of the four patients had clinical abnormalities, such as ascites, esophageal varices or a history of hepatic encephalopathy, that may indicate advanced liver dysfunction and/or presence of collateral circulation. These findings suggest that the occurrence of keto bile acids in the urine might be ascribed to the escape of these acids from reduction to hydroxy-forms in the liver, not to bacterial over-production in the intestine. However, the mechanism and significance of the presence of keto bile acids in the urine are still unknown.

Topics: Adult; Ascites; Bile Acids and Salts; Chenodeoxycholic Acid; Deoxycholic Acid; Esophageal and Gastric Varices; Feces; Hepatic Encephalopathy; Humans; Lithocholic Acid; Liver Cirrhosis; Male; Middle Aged