Serum, fecal and urinary bile acids in patients with mild and advanced liver cirrhosis.

The levels and compositions of bile acids in the serum, feces and urine were determined by gas chromatography in male patients with mild and advanced stages of liver cirrhosis, defined by usual clinical and laboratory criteria. Increased concentrations of serum bile acids, a decreased ratio of serum cholic acid plus deoxycholic acid/chenodeoxycholic acid plus lithocholic acid, a reduction of fecal bile acids, especially deoxycholic acid, and a reduction in total daily excretion of bile acids were found in patients with advanced cirrhosis. Furthermore, 3 beta-hydroxy-5-cholenoic acid, a presumed intermediate in the alternate pathway of chenodeoxycholic acid synthesis, was found in the urine of patients with very advanced cirrhosis. Such changes were absent in patients with mild cirrhosis except for increased concentration of serum bile acids and decreased excretion of total bile acids. The present study suggests that marked changes in bile acid metabolism occur only in advanced cirrhosis.