Effect of ursodeoxycholic acid treatment on ileal absorption of bile acids in man as determined by the SeHCAT test

Article Abstract:

Bile acids are produced by the liver and released into the small intestine in response to a meal; they aid in the efficient absorption of dietary fat and cholesterol. The bile acids are reabsorbed at a more distal point in the intestine, after they have accomplished their function, and return to the liver via the bloodstream where they await reentry into the cycle. The release and reabsorption of bile acids are part of a tightly controlled feedback cycle in which the rate of bile acid biosynthesis is regulated by both the demand for these compounds by the digestive tract and the rate at which they return to the liver. Ursodeoxycholic acid, a derivative of the major bile acids (and itself a minor constituent of bile) has been used in the treatment of a variety of disorders, including gall stones, primary biliary cirrhosis, and sclerosing cholangitis. The extent to which beneficial effects of ursodeoxycholic acid treatment may be related to its influence on intestinal absorption of bile acids is not known. To further investigate this issue, a newly available tracer technique involving monitoring the absorption of radioactively labelled selenium homocholic acid taurine (an easily measurable analog of naturally occurring bile acids) was used to quantify the effects of ursodeoxycholic acid on bile acid absorption. The radiolabelled acid was given orally, and bile acid absorption inferred from the rate of disappearance of radioactivity over a seven-day period. This was done before and after three weeks of treatment with ursodeoxycholic acid. Following treatment, there was a significant decrease in intestinal absorption of bile acids and blood cholesterol levels; blood levels of ursodeoxycholic acid increased. These results suggest that the beneficial effects of ursodeoxycholic acid treatment result, at least in part, from its suppressive actions on the absorption of bile acids. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cholesterol, Bile acids

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Antigliadin and antiendomysium antibody determination for coeliac disease

Article Abstract:

It is normal for the body to produce low levels of antibodies that recognize proteins ingested from food. However, studies have suggested that elevated levels of antibodies against gliadin (a protein in wheat) occur in patients with gluten enteropathy, intestinal disease caused by eating wheat-containing foods. This occurrence may be important in the mechanism of the disease as well as in its diagnosis. Antibodies against endomysium (tissue that binds fibers together in a muscle) have also been associated in patients with celiac disease (gluten intolerance). Antibodies, immunoglobulins, can be divided into subclasses, and the levels of IgG and IgA (immunoglobulins of subclasses G and A) in the group of anti-gliadin antibodies (AGA) may be important in diagnosis of the disease. The diagnostic significance of IgG and IgA AGA, and of IgA endomysium antibodies (EMA), in 340 of 551 patients suspected of having celiac disease was investigated. Of 340 children with untreated celiac disease, 306 were positive for EMA, 335 had IgG AGA, and 274 had IgA AGA. Of 211 children without celiac disease, four were positive for EMA, while 12 had IgA AGA and 74 had IgG AGA. Celiac patients under two years old had IgA EMA less often. Detection of blood levels of both AGA and EMA was highly related to the presence of celiac disease. Antibody levels decreased as duration of gluten-free diets increased. As many as 34 of 169 patients who were challenged with gluten for at least two years had no pathological changes in intestinal tissue, indicating that they likely had a transient form of celiac disease. Alternatively, they might relapse as gluten challenge continued. Patients challenged with gluten more often had detectable blood levels of EMA, so this antibody was more indicative of cases of silent relapse of celiac disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Celiac disease, Antibodies

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Effects of ursodeoxycholic acid treatment on nutrition and liver function in patients with cystic fibrosis and longstanding cholestasis

Article Abstract:

Cystic fibrosis (CF) is an incurable inherited disease characterized by chronic respiratory infection and an inability of the pancreas to produce sufficient enzymes to properly digest food. With improvements in therapies directed against the respiratory infections, patients suffering from CF now survive into their twenties (compared with an average life span of only 14 years in 1969). As more patients live longer, liver and biliary tract problems are seen more frequently. In particular, cholestasis, or impaired bile flow, can produce nutritional deficits. In other conditions involving cholestasis, administration of the bile salt ursodeoxycholic acid (UDC) has been shown to stimulate bile flow and improve nutrition. To determine whether these beneficial effects would also be seen in CF patients, eight patients (aged 10 to 25) were given a six-month course of treatment with UDC. Following the treatment, bile flow was significantly improved. Liver function improved significantly on most indices in all patients; there was a slight deterioration of functional liver cell mass as measured by the galactose elimination test. Nutritional status of the patients increased, and they gained an average of four pounds, with a corresponding increase in muscle mass. Steatorrhea (the passing of fatty stools) was not affected by UDC treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Cystic fibrosis, Cholestasis, Biliary tract diseases, Bile salt metabolism

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