Bile Acids - Clinical Significance

Clinical Significance

Since bile acids are made from endogenous cholesterol, the enterohepatic circulation of bile acids may be disrupted to lower cholesterol. Bile acid sequestrants bind bile acids in the gut, preventing reabsorption. In so doing, more endogenous cholesterol is shunted into the production of bile acids, thereby lowering cholesterol levels. The sequestered bile acids are then excreted in the feces.

Tests for bile acids are useful in both human and veterinary medicine, as they help to diagnose a number of conditions, including cholestasis, portosystemic shunt, and hepatic microvascular dysplasia.

Excess concentrations of bile acids in the colon are a cause of chronic diarrhea. This condition of bile acid malabsorption can be diagnosed by the SeHCAT test and treated with bile acid sequestrants.

The role of black bile in carcinogenesis was suggested already by Hippocrates. Today it is well-documented that bile acids are carcinogens and tumor promoters in experimental models. Their role in carcinogenesis is best documented in Barrett's esophagus and adenocarcinoma at the gastroesophageal junctions.