Determination of 14CO2 in breath and 14C in stool after oral administration of cholyl-1-[14C]glycine: clinical application

Twenty patients with intestinal bacterial overgrowth and 20 control subjects were investigated for bile acid deconjugation, by measuring 14CO2 in the breath after cholyl-1-[14C]glycine administration. 14CO2 output/24h was 11.0 +/- 5.2% (mean +/- SD) in controls and 54.2 +/- 14.0% (mean +/- SD) in bacterial-overgrowth patients (P less than .001). 14CO2 excretion rate in 12h, when normalized to 100% of the dose at the 12th hour, gave an even finer discrimination between the two groups (no false responses). 14C in stool, analyzed in 20 malabsorption patients and 20 controls by two different techniques, was 6.6 +/- 4% and 31.38 +/- 21.7% (mean +/- SD), respectively. Results by the two different techniques described here correlated well (r = .99). Bile acid malabsorption was in reasonable agreement (r = .67) with percentage of "chenoid" (chenodeoxycholic acid plus ursodeoxycholic acid) in the stool by gas-liquid chromatography; a poorer correlation was observed when "chenoid" plus "choloid" (cholic acid plus its epimers) were plotted vs. -4C in stool (r = .57, n = 15).

Development, validation, and application of a single-tube radioimmunoassay for cholic and chenodeoxycholic conjugated bile acids in human serum

A single-tube radioimmunoassay for both cholic acid and chenodeoxycholic acid conjugates in serum is based on the use of [1-(14)C]glycocholic acid and [H-3H]glycochenodeoxycholic acid as tracers. The assay was shown to be specific, sensitive, accurate, and precise (CV = 13% at low concentrations, 5.5% at higher concentrations) when used for serum samples from subjects and patients with increased bile acid in the serum because of liver disease, and results correlate well with those by gas chromatography (r = .99).

Determination of 14CO2 in breath and 14C in stool after oral administration of cholyl-1-[14C]glycine: clinical application

Twenty patients with intestinal bacterial overgrowth and 20 control subjects were investigated for bile acid deconjugation, by measuring 14CO2 in the breath after cholyl-1-[14C]glycine administration. 14CO2 output/24h was 11.0 +/- 5.2% (mean +/- SD) in controls and 54.2 +/- 14.0% (mean +/- SD) in bacterial-overgrowth patients (P less than .001). 14CO2 excretion rate in 12h, when normalized to 100% of the dose at the 12th hour, gave an even finer discrimination between the two groups (no false responses). 14C in stool, analyzed in 20 malabsorption patients and 20 controls by two different techniques, was 6.6 +/- 4% and 31.38 +/- 21.7% (mean +/- SD), respectively. Results by the two different techniques described here correlated well (r = .99). Bile acid malabsorption was in reasonable agreement (r = .67) with percentage of "chenoid" (chenodeoxycholic acid plus ursodeoxycholic acid) in the stool by gas-liquid chromatography; a poorer correlation was observed when "chenoid" plus "choloid" (cholic acid plus its epimers) were plotted vs. -4C in stool (r = .57, n = 15).

Development, validation, and application of a single-tube radioimmunoassay for cholic and chenodeoxycholic conjugated bile acids in human serum

A single-tube radioimmunoassay for both cholic acid and chenodeoxycholic acid conjugates in serum is based on the use of [1-(14)C]glycocholic acid and [H-3H]glycochenodeoxycholic acid as tracers. The assay was shown to be specific, sensitive, accurate, and precise (CV = 13% at low concentrations, 5.5% at higher concentrations) when used for serum samples from subjects and patients with increased bile acid in the serum because of liver disease, and results correlate well with those by gas chromatography (r = .99).

[Medical treatment of cholesterol cholelithiasis using chemodeoxycholic acid in man]

The results of a tiral using chenodeoxycholic acid in 400 patients with cholesterol gallstones are reported. The "qualifying points" of such treatment are compared with the literature data in clinical and laboratory terms. 54% of 300 in clinical and laboratory terms. 54% of 300 patients who received less than 12 mg/kg/day achieved dissolution in a mean time of 11 months, while 64% of the remainder (12-15 mg/kg/day) did so in an average of 8 months. Microcalculi proved most sensitive to treatment (65% of positive results). Lithiasis over 5 years standing and over-weight (10% over the ideal figure) were factors that imposed more protracted treatment. Careful selection of candidates was proved important by the results of quarterly liver and intestine performance examinations. These were more extensive and more clearly aimed than those proposed by other workers. They showed that the acid is neither hepato nor enterotoxic. Indeed, no serious side-effects were noted.

[Results of chenic acid therapy in patients with cholesterol calculi]

58 patients suffering from cholesterol gallstones were treated with chenodesoxycholic acid at a dose of 2-15 mg/Kg/die for about 15 months so as to determine its effettiveness and establish a minimum effective dose. 8 of these patients presented stones in the common bile duct. The results showed: a complete dissolution of the stones in 16 of the 50 patients considered to be suffering from cholecystic lithiasis; partial dissolution in 15; no change in the remaining 19. Of the 8 patients with bile duct stones, 3 presented complete dissolution, 2 partial, and 3 no change. An improvement in digestive function was observed in most cases. The liver function tests carried out in each patient before, during and after treatment with chenodesoxycholic acid were completely normal.

[Correlation of malabsorption of bile acids, bile lipid composition and calculi]

The relation between malabsorption of bile acids, the bile lipid composition, and biliary stones was examined in 8 patients subjected to ileal resection (particularly for Crohn's disease), 6 with ileal bypass for morbid obesity, and 10 healthy controls. The 1-14C-cholylglycine breath test was employed to detect of the absorption and deconjugation of bile acids. Bile lipid composition was expressed according with Metzger's saturation index. Healthy subjects gave normal findings in all respects, whereas ileal resection was accompanied by malabsorption, increased deconjugation, and faecal loss of 14C. These changes, particularly malabsorption, were more evident after ileal bypass. Preoperative saturation values rose to more than 1 in all cases, especially after resection. Liver disease (steatosis and cirrhosis) 6 months after bypass, together with cholesterol lithiasis in 2/6 patients.

[Changes in bile and blood lipid levels following chenodeoxycholic acid therapy]

Original and known methods and ordinary routine tests were used to evaluate changes in bile salts, phospholipids and cholesterol and in serum lipids induced in 50 patients during treatment with chenodeoxycholic acid (2-12 mg/Kg/day) for about 15 months. No significant differences in serum lipids, though a clear fall in triglycerides was noted in those who received 7-12 mg/Kg/day as opposed to 2-7 mg/Kg/day. There was a marked fall in the molar percentage of biliary cholesterol, followed by a significant reduction in the saturation index of Metzger. Once again, greater reduction was noted in patients receiving the higher dose range. A correlation between the dose used and the percentage of cholesterol in the bile was thus evident. After treatment, chenodeoxycholic acid was the main bile acid and there was a significant fall in cholic and deoxycholic acid. The desired drug effect can be obtained with low doses (7-12 mg/Kg/day) and a biliary chenodeoxycholic value well below 90%.

A radioimmunoassay of primary bile acid conjugates in human serum

The fasting levels of chenodeoxycholic and cholic acid conjugates in various groups of patients [25 healthy subjects, 20 patients with chronic active liver disease (CALD), 21 patients with primary biliary cirrhosis (PBC) and 5 patients with cholesterol gallstones before and after chenodeoxycholic acid therapy] were determined by using a sensitive, accurate and precise radioimmunoassay. The results obtained with this method were compared with those of a gas-chromatographic method with methylation and acetylation of the bile acids using a 2 m x 0.4 cm glass column packed with 3% of AN 600 on Anakrom Q 110-120 mesh. The results obtained with both methods are in agreement; therefore the method used can be applied for quantitative analysis. In diagnosis, the measurement of serum bile acid levels, fasting or after meals, proved to be a very sensitive method, although further correlations are necessary with standard liver function tests.

The medical treatment of cholesterol gallstones: experience with chenodeoxycholic acid

Chenodeoxycholic acid has been administered to 50 patients with cholelithiasis and 8 with choledocholithiasis for a period of 15 months at doses varying between 2- and 15 mg/kg/day. Among the 50 patients with cholelithiasis, complete dissolution occurred in 16 and partial dissolution in 15 cases. Among the 8 patients with choledocholithiasis, complete dissolution occurred in 3 and partial dissolution in 2 cases. Lower doses were adopted in an attempt to determine the minimum effective daily dose required to produce gallstone dissolution and to lower the cholesterol saturation index (mean 1.52 +/- 0.73 before and 0.98 +/- 0.36 after treatment). Routine liver function tests were carried out before, during and after treatment; no significant alterations were produced by therapy. Studies of the antipyrine half-life, to estimate hepatic microsomial function were found to be normal (mean 13.61 +/- 2.62 before and 13.21 +/- 3.04 after treatment). In addition, histological investigations of the liver were described. This study confirms the efficacy of chenodeoxycholic acid in the treatment of cholesterol gallstones and gives an indication of the minimum effective dose (7.8 mg/kg/day). At the present doses, it has been shown that there are no substantial modifications in fundamental liver function.

[Therapy of cholesterol lithiasis with chenodeoxycholic acid (Chenoxyl)]

Chenodesoxycholic acid (500-750 mg/day Chenoxyl) was employed over a period of 9 months in the treatment of 40 patients with radiotransparent calculi in a functioning gallbladder and 8 with choledochal lithiasis. Radiological examination and complete hepatological exploration were carried out before and after the treatment in all cases. Complete dissolution was obtained in 6 and 2 cases respectively, with reduction of size in 13 and 2, and no change in 21 and 4. No significant variations were notes in the blood lipid picture or in liver function. There were no cases of diarrhoea.