CHOLESTYRAMINE LOADING TEST TO ASSESS HEPATIC RESERVE FOR BILE-ACID SYNTHESIS IN PATIENTS WITH CHRONIC LIVER-DISEASES

Background & Aims: Serum 7 alpha-hydroxycholesterol level reflects hep atic bile acid synthesis in humans. The aim of this study was to exami ne the maximal bile acid synthesis in patients with chronic liver dise ases. Methods: Cholestyramine (12 g/day) was administered for 3 days t o patients with compensated liver cirrhosis (n = 7), patients with chr onic hepatitis (n = 10), and control subjects (n = 9), and serum total 7 alpha-hydroxycholesterol level was measured by gas-liquid chromatog raphy-mass spectrometry. Results: A preliminary study showed that chol estyramine increased the serum value to the maximum by the third day. Before cholestyramine treatment, there were no significant differences in serum 7 alpha-hydroxycholesterol levels among the groups. Three da ys of cholestyramine treatment increased the serum levels 5.71 +/- 2.9 0-fold in the controls, 3.25 +/- 0.85-fold in patients with chronic he patitis, and 1.70 +/- 0.78-fold in cirrhotic patients. Cirrhotic patie nts had significantly lower serum 7 alpha-hydroxycholesterol levels af ter the treatment compared with other groups. Serum 7 alpha-hydroxycho lesterol levels stimulated by cholestyramine significantly correlated with serum albumin levels and indocyanine green retention rate. Conclu sions: Three days of cholestyramine loading increased the bile acid sy nthesis to its maximal level. The cholestyramine test showed that pati ents with chronic hepatitis had enough hepatic reserve for bile acid s ynthesis; however, patients with compensated liver cirrhosis had signi ficantly decreased capacity.