phytosterols and Cholestasis--Intrahepatic

Our aim was to investigate whether intestinal binding of bile acids by guar gum, a dietary fibre, relieves cholestasis and pruritus in intrahepatic cholestasis of pregnancy.. Forty-eight pregnant women with cholestasis and pruritus were randomized double-blind to guar gum and placebo until the time of delivery, and 20 healthy pregnant women were used as control subjects. The pruritus score and serum bile acids, lipids and non-cholesterol sterols were measured at baseline, at least 2 weeks after treatment, just before delivery and up to 4 weeks after delivery.. The increase in serum bile acids and worsening of pruritus were prevented by guar gum in relation to placebo (P < 0.05). Serum cholesterol was unchanged, but increased cholesterol precursor sterol values suggested that cholesterol synthesis was increased by guar gum. Serum cholestanol proportion, an indicator of cholestasis, was related to pruritus but was unaffected by guar gum.. We conclude that in intrahepatic cholestasis of pregnancy and pruritus, guar gum treatment is beneficial in relieving pruritus, even although indicators of cholestasis are only partially reduced.

Topics: Administration, Oral; Adult; Cholestanol; Cholestasis, Intrahepatic; Cholesterol; Desmosterol; Dietary Fiber; Double-Blind Method; Female; Galactans; Humans; Mannans; Phytosterols; Plant Gums; Pregnancy; Pregnancy Complications; Pruritus; Random Allocation; Sitosterols

Topics: Adolescent; Child, Preschool; Cholestasis, Intrahepatic; Female; Gas Chromatography-Mass Spectrometry; Humans; Infant; Liver; Liver Diseases; Male; Parenteral Nutrition; Phytosterols

Infants on long-term parenteral nutrition frequently will have progressive cholestatic liver disease, the cause of which remains largely unknown. The aim of this study is to establish a possible role for plant sterols (phytosterols) in the pathogenesis of parenteral nutrition-associated cholestasis (PNAC).. Two experimental studies were used: (1) A study on neonatal piglets involved the daily injection of plant sterols; measurement of their concentrations in serum, liver, and bile during a 14-day period; and determination of serum bile acid concentrations, bile acid secretion, and bile flow at the end of the 14-day period. (2) Isolated rat hepatocyte couplets were used to study the effects of sterols on canalicular secretion.. The daily injection of phytosterols (in amounts similar to those given to infants who receive parenteral nutrition) led to their progressive accumulation in the piglets' serum, liver, and bile. Serum bile acid levels were significantly higher in the sterol-treated piglets. Maximal bile acid excretion was significantly lower in the sterol group. Phytosterols caused a significant inhibition of secretory function in isolated rat hepatocyte couplets.. Important contaminants of commercial lipid emulsions (phytosterols) have been identified as a possible cause of PNAC.

Topics: Animals; Animals, Newborn; Awards and Prizes; Bile Acids and Salts; Bile Canaliculi; Cells, Cultured; Cholestasis, Intrahepatic; Fat Emulsions, Intravenous; Food, Formulated; General Surgery; Humans; Infant; Liver; Parenteral Nutrition; Phytosterols; Rats; Societies, Medical; Swine; United Kingdom