A pilot study on the hemodynamic effect of short-term ursodeoxycholic acidtherapy in patients with stable liver cirrhosis

OBJECTIVE: Total serum bile acid concentrations are elevated in individuals with Liver disease. Ursodeoxycholic acid (UDCA) therapy in such patients r esults in a further significant rise in plasma levels to the extent that it becomes the major circulating bile acid. In laboratory animals, bile acids , such as taurocholic acid, have also been shown to possess a diuretic-like action, as they can promote diuresis, natriuresis, and kaliuresis by inhib iting tubular sodium reabsorption. The aim of the present study was to asse ss the effect of 1 month's UDCA therapy on cardiovascular function in cirrh otic patients. METHODS: Two groups of patients with cirrhosis were studied, six with prima ry biliary cirrhosis (PBC) and six with postnecrotic liver cirrhosis (PNC). Cardiovascular function was assessed by determination of blood pressure, h eart rate, and by two-dimensional and pulsed Doppler echocardiography. RESULTS: In PBC patients, 1 month's treatment with UDCA significantly reduc ed diastolic volume without changing systolic, diastolic, and mean blood pr essures, heart rate, systolic and stroke volumes, ejection fraction, cardia c output, and systemic vascular resistance. In PNC patients, UDCA significa ntly reduced cardiac output, with a tendency to reduce left ventricular vol umes, without any changes in systolic, diastolic, and mean blood pressures. CONCLUSIONS: UDCA caused reductions in diastolic volume in the PBC patients and cardiac output in the PNC patients. Such reductions are not unlike tha t seen in individuals treated with diuretics. This diuretic-like action des erves further study, particularly in cirrhotic patients who are also being treated with diuretics or show evidence of cardiac myopathy. (C) 1999 by Am . Coll. of Gastroenterology.