Ileal absorption of bile acids in patients with chronic cholestasis

The effect of cholestasis on ileal bile acid absorption is controversial in animal models (up-or down-regulation) and unknown in humans. We therefore studied values of the selena homotaurocholic acid (SeHCAT) test before and after long-term administration (>3 months, 13–15 mg/kg/day) of ursodeoxycholic acid (UDCA) in 27 patients with chronic cholestatic liver diseases (24 women, 3 men; mean age, 50 years; 24 primary biliary cirrhosis, 2 secondary biliary cirrhosis, 2 others). The control group consisted of 14 healthy volunteers. Seven-day SeHCAT percentage retention was identical in the 12 untreated cholestatic patients (serum bilirubin, 75 ± 42 µmol/L, alkaline phosphatase, 4.2 ± 1.0N; mean ± SEM) and in the control group (43.6 ± 2.9 and 43.8 ± 4.2%, respectively). In the 22 patients treated by UDCA for 38 ± 8 months, SeHCAT percentage retention was 20.3 ± 3.0%. In the seven patients with the SeHCAT test done before and after UDCA treatment (16 ± 5 months), SeHCAT percentage retention decreased significantly under UDCA therapy (42.0 ± 4.4 vs 19.4 ± 4.1%; P < 0.02). We conclude that, in patients with chronic cholestasis (1) SeHCAT percentage retention is not altered—taken together with the known defect of biliary excretion, this lack of increase in SeHCAT percentage retention argues against up-regulation of bile acid ileal transport; and (2) UDCA treatment induces a decrease in the SeHCAT percentage retention—this effect may be related primarily to a decreased bile acid ileal absorption.