Serum bile acids and the bile acid tolerance test under oral contraception
Van Berge Henegouwen, G.P.; van der Werf, S.D.
Hepato-Gastroenterology 39(2): 177-180
1992
ISSN/ISBN: 0172-6390 PMID: 1634184 Document Number: 746
Gastroenterologists analyzed data on 12 19-30 year old, healthy hospital nurses and medical school students in either Utrecht or Arnhem, the Netherlands to study the endogenous bile acid tolerance test before and after oral contraceptive (OC) use and to examine likely changes in the enterohepatic circulation of each bile acid during OC use. The OCs contained 30 mcg ethinyl estradiol and 150 mcg desogestrel. The study did not reveal a strong correlation between serum chenodeoxycholate (CDC) measurements and CDC pool size, thus clinicians should not use them to monitor changes in CDC pool sizes in individuals. They could use serum CDC measurements, however, to monitor CDC pool size changes as a result of pharmacological manipulation with bile acid therapy or estrogen treatment in larger groups of people. During the study, the area under the curve (AUC) of CDC conjugates and serum CDC peak levels was 40% lower during OC use than it was when the women did not use OCs (p.01 and p.02, respectively). The reduction in the AUC of serum CDC peak levels may have been a result of a sharp increase in taurine conjugates of all bile acid classes during OC use. The even stronger reduction in the AUC of CDC conjugates may be because hepatic extraction of taurine conjugates are more efficient than of glycine conjugates. Glycine amidated CDC is somewhat passively absorbed at the proximal small intestinal level while taurine CDC is not. Thus more distal absorption of taurine-enriched CDC in the small intestine occurs. They very small increase in CDC conjugates after cholecystokinin infusion during OC use is somewhat like what happens during pregnancy.
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