Postprandial changes in serum concentrations of individual bile salts in normal subjects and patients with acute viral hepatitis

Abstract

A sensitive gas-liquid chromatographic assay has been used to analyze serum concentrations of the four major bile acids in both sulfated and nonsulfated forms. Twelve control subjects have been compared with 40 patients with acute viral hepatitis whose symptoms had been present from 6 to 34 days. In all subjects blood samples were collected fasting and 2 hr after a standard meal. In addition half-hourly samples were assayed for 3 hr after the meal in 6 controls and 5 patients with acute viral hepatitis. In both the control and hepatitis groups, serum concentrations of nonsulfated bile acids, especially cholic and chenodeoxycholic acids, increased after the meal. The peak levls usually occurred between 60 and 120 min in the half-hourly studies. In contrast, sulfated bile acids fell in both groups with minimum levels 60–120 min after the meal. Serum total bilirubin, aspartate aminotransferase, and alkaline phosphatase concentrations in hepatitis patients correlated significantly with postprandialitotal bile acid concentrations but were more frequently abnormal than serum total or individual bile acids. Unconjugated bile acids were not detected in control subjects but were found in 17 of the 40 hepatitis patients. Significantly higher levels of sulfated bile acids and chenodeoxycholic acid were present in hepatitis patients compared to controls. In this group of patients with acute viral hepatitis, studied soon after presentation to hospital but in some cases, some time after the onset of their disease, measurement of serum bile salts was not helpful as an index of hepatocellular function. Postprandial variation in the time of peak concentrations of the individual bile acids resulted in the postprandial bile acid studies being no more useful than fasting assays in distinguishing patients with acute viral hepatitis from control subjects.