Serum bile acids in cirrhosis depend on aetiology

A Horvath; B Leber; E Krones; G Zollner; P Fickert; RE Stauber; S Lemesch; W Spindelboeck; F Durchschein; P Douschan; P Stiegler; T Stojakovic; G Fauler; V Stadlbauer

doi:10.1055/s-0035-1551779

Zeitschrift für Gastroenterologie, Table of Contents

Serum bile acids in cirrhosis depend on aetiology

A Horvath ¹, B Leber ¹, E Krones ¹, G Zollner ¹, P Fickert ¹, RE Stauber ¹, S Lemesch ¹, W Spindelboeck ¹, F Durchschein ¹, P Douschan ¹, P Stiegler ¹, T Stojakovic ¹, G Fauler ¹, V Stadlbauer ¹

¹Medical University Graz, Graz, Austria

Abstract

Background:

Elevated serum bile acid levels are suggested to be a diagnostic tool as well as a predictor for mortality. After synthesis in the liver, and metabolization by intestinal microflora, bile acids are re-internalized. Characteristic liver damage, changes in microbiome and gut barrier dysfunction are likely to influence bile acid profilesaetiology-dependent. Therefore, we examined changes in bile acid profiles typical for different aetiologies of cirrhosis.

Methods:

Bile acid profiles of 101 cirrhotic patients (56 alcoholic, 20 chronic hepatitis C, 25 others) and 10 healthy controls were determined with tandem mass spectrometry. Sucrose recovery and lactulose-mannitol-ratio by differential sugar absorption test (HPLC), permeability markers were measured by ELISA.

Results:

All groups of cirrhotics show higher concentration of total bile acids, most pronounced in alcoholic cirrhosis. Primary bile acids are particularly high in alcoholic cirrhosis, but not secondary bile acids. Consequently, secondary to primary bile acid ratio is significantly reduced. HCV induced cirrhosis show a similar ratio while absolute values are approximately half of the values in alcoholic cirrhosis. Conjugated bile acid concentration is increased in all patient groups; particularly high in alcoholic cirrhosis. Unconjugated bile acids are significantly increased in alcoholic and other cirrhoses, but remain close to normal in HCV induced cirrhosis. Taurin to glycin conjugated bile acid ratio is significantly increased in alcoholic and HCV induced cirrhosis compared to healthy controls and other aetiologies. Gut permeability is also elevated in all cirrhosis groups, however no clear association between serum bile acids and permeability markers could be found.

Conclusion:

Serum bile acid concentration and composition is strongly dependent on aetiology of cirrhosis. A possible explanation could be that the microbiome is subjected to different modulators specific for different aetiologies. Associations between gut permeability were weak and their clinical relevance is questionable.