Defective bile acid biosynthesis, metabolism, and transport can now be deli
neated in a wide variety of disease states. This ability to recognize speci
fic aberrations, such as the documented inborn errors in bile acid biosynth
esis manifesting as neonatal cholestasis, offers new opportunities for ther
apeutic intervention. Future studies should determine the incidence of bile
acid biosynthetic and transport defects in patients with enigmatic and une
xplained liver diseases.