Bile acid metabolism in patients with cirrhosis. I. Kinetic aspects of cholic acid metabolism.

Labeled cholic acid was administered orally to 8 patients with cirrhosis and no ascites. Bile-rich duodenal fluid was obtained at daily intervals for periods up to 7 days, and bile acid composition and cholic acid specific activity were determined. The total and component bile acid pools, cholic acid production, and half-life were estimated from the data and compared with a group of our patients without liver disease previously reported. The total and component bile acid pools were markedly reduced in patients with cirrhosis. The total bile acid pool was 46% smaller in cirrhotic patients than the control patients (1.3 g versus 2.4 g). There was a virtual absence of biliary deoxycholic acid in 7 of 8 patients with cirrhosis. Cholic acid production in the cirrhotic patients was approximately one-third that of the normal group. A prolongation of the cholic acid turnover time was also noted in 3 of the 8 cirrhotic patients. It is suggested that in patients with cirrhosis the failure of the liver to produce adequate amounts of bile acids is responsible for the diminished bile acid pool. The nonpancreatogenic steatorrhea observed in some patients with cirrhosis might be attributed in part to a lack of sufficient bile salts in the intestine.