Serum bile acids in schistosomotic hepatic fibrosis.

Serum b ile acid determ ination has b een cla im ed as a se n s it iv e liv e r fu n ctio n test in chron ic hepatic d ise a se and sev era l papers ha v e b een pu b lish ed a sse s s in g seru m b ile a c id s (m ore sp ec ific a lly c h o l i l g l y c i n e ) in h e p a t ic s c h i s t o s o m ia s i s , su g g es tin g that th is d eterm ination can b e o f va lu e in the stu dy o f such patien ts5 1. Z w in g erb erg er et a l6 fou n d a d istin ctiv e va lu es fo r h ep a to in testin a l (H I) and h ep atop len ic (H S) p a tien ts, bu t co u ld n o t foun d d ifferen ces betw een co m p en sa ted and d ecom p en sated H S p atien ts w ith a v ery s im ila r v a lu e s fo r b o th g rou p s. A ccord in g to th e se a u th o rs , the in crea sed c h o lilg ly c in e co n cen tra tion in th e serum o f H S patien ts, w o u ld b e related to th e m o d ifica tio n s in th e sinu so ida l e n d o th e liu m and the b yp ass o f the liv er b y the p o rto -ca v a l sh u n tin g . T h e se fin d in g s w o u ld b e in a greem en t w ith experim en ta l stu d ies , w h ere a tem p oral a sso c ia tio n b e tw een the d ev e lo p m en t o f h ep a tic f ib ro sis in m urine hepatic sch isto so m ia sis and in crea sin g c h o lilg ly c in e concen tration in the perip hera l b lo o d is fo u n d 1. S u ch p r o p o s it io n is n o t en tire ly c o n v in c in g , s in c e it is b e lie v e d that s in u so id a l m o rp h o log ica l f ib ro sis is n o rm a lly fou n d in patients w ith the d eco m p en sa ted form o f H S sch isto so m ia s is2 3. F urtherm ore i f the sp illo v e r o f b ile ac id s to the sy stem ic c ircu lation b ecause o f porto-caval shunting resu ltin g fro m portal h y p erten sion , w o u ld increase th e c h o lilg ly c in e le v e ls in th e serum , the overn igh t fastin g can r ec y c le th e b ile ac id s severa l tim es throu gh the l iv e r c ircu la tio n , and the fasten le v e ls o f c h o ly lg ly c in e co u ld b e n orm alized , depend ing o n the h ep atic fu n ctio n . T h is theoretica l h yp o th esis can b e su pp orted b y th e data ob ta ined in hepatic c irrh o sis w h ere severa l p atien ts w ith estab lished h ep atic c irrh o sis presen t norm al serum b ile acids le v e ls . In ou r p r e v io u s ly p u b lish ed w o rk 5 the m ean v a lu e s fo r fastin g serum c h o lilg ly c in e w a s m ore