Ursodeoxycholic acid (UDCA) has beneficial effects in cholestatic liver dis
eases. Absorption of UDCA is slow and incomplete. In the present study the
effect of cholestasis on absorption was evaluated in 10 patients with pancr
eatic carcinoma and extrahepatic biliary drainage. At days 3 and 10 after i
nsertion of the biliary drain, all patients received 750 mg UDCA in three d
ivided doses. On both occasions intestinal absorption of UDCA was determine
d to evaluate the influence of cholestasis. Serum bilirubin was used as ind
icator of cholestasis. Biliary output of UDCA served as measure of absorpti
on and was determined by gas-liquid chromatography. At days 4 and 11 bile c
onsisted of less than 2% of UDCA, indicating that UDCA excretion was comple
te within 24 hr and no accumulation of UDCA had occurred. After insertion o
f the drain, serum bilirubin decreased from 12.2 +/- 2.4 mg/dl at day 3 to
5.4 +/- 0.9 mg/dl at day 10. Biliary secretion of bile acids increased from
2.0 +/- 0.3 to 3.1 +/- 0.4 mmol/day, whereas percentage of ursodeoxycholic
acid in bile did not significantly increase (41.1% vs 42.1%). Absorption o
f UDCA increased from 39.8 +/- 5.0% to 61.1 +/- 6.2% of the administered do
se, indicating an improvement of the absorption rate after decrease of chol
estasis by 53.65% (P < 0.05). In conclusion, in severe cholestasis absorpti
on of orally administered UDCA is markedly reduced. This may have implicati
ons in the treatment of patients with cholestatic disease.