SERUM BILE-ACIDS AND CHOLESTASIS IN ALCOHOLIC HEPATITIS - RELATIONSHIP WITH USUAL LIVER TESTS AND HISTOLOGICAL FEATURES

Cholestasis is a biochemical and/or histological feature observed in s ome patients with alcoholic liver disease and is mainly related to alc oholic hepatitis. Accumulation of bile acids in the liver could be pat hogenic in alcoholic hepatitis. The aim of this study was to assay ser um bile acids in patients with alcoholic hepatitis and to assess the r elationship between these parameters, the usual liver tests and the hi stological features of alcoholic hepatitis. Thirty-six patients (media n 51 years, 19 females and 17 males) with biopsy-proven alcoholic hepa titis were included in the study. Cirrhosis was present in 27 patients . Serum bile acids were assayed by high performance liquid chromatogra phy. Three histological scores (alcoholic hepatitis, fibrosis, and cho lestasis) were established on each liver sample by two independent pat hologists. Serum bile acid concentrations were increased in 35 patient s (97%). The median concentration of total serum bile acids was 41.6 m u mol/l (range 3-293), with an increase in primary bile acids (95.7% o f total bile acids), mainly chenodeoxycholic acid (median 27.5 mu mol/ l, range 3-184). In contrast, serum bilirubin levels were increased in only 26 patients (72%). Histological cholestasis was present in 14 pa tients (38%). There was no significant correlation between the alcohol ic hepatitis and cholestasis scores (r=0.01, p=0.9). A significant cor relation was noted between the alcoholic hepatitis score and serum tot al bile acid (r=0.34, p=0.04), cholic acid (r=0.38, p=0.03) and chenod eoxycholic acid (r=0.32, p=0.05) levels. No correlation was noted betw een serum bile acid levels and cholestasis (r=0.13, p=0.4) or fibrosis scores (r=0.12, p=0.5). Conversely, the bilirubin level was correlate d with the cholestasis score (r=0.40, p=0.02), but not with the alcoho lic hepatitis (r=0.10, p=0.5) or fibrosis scores (r=0.17, p=0.31). Thi s study suggests that the histological lesions of alcoholic hepatitis could be related, in part, to an increase in primary bile acids. Furth er studies are required to assess the effect of ursodeoxycholic acid a s a treatment for alcoholic hepatitis. (C) Journal of Hepatology.