Deoxycholate metabolism in alcoholic cirrhosis.

Deoxycholate is often absent in bile of patients with alcoholic cirrhosis. The purpose of this study was to define the mechanism for this abnormality in bile acid metabolism in alcoholic cirrhosis. Excretion and hepatic metabolism of exogenous [14C]deoxycholate were determined, quantitative and qualitative analyses of fecal bile acids were performed, and ability of fecal bacteria to metabolize cholate to deoxycholate in vitro was measured both in cirrhotic patients and in controls. There was no evidence for deoxycholate malabsorption or rehydroxylation. In cirrhotic patients without biliary deoxycholate, both in vivo levels of deoxycholate and lithocholate in feces and in vitro fecal bacterial conversion of cholate to deoxycholate were significantly decreased as compared to controls. The marked decrease in 7 alpha-dehydroxylase activity of fecal bacteria of some patients with alcoholic cirrhosis results in impaired conversion of cholate to deoxycholate and explains the lack of biliary deoxycholate in these patients.