RESUMEN
BACKGROUND: Bile acid malabsorption (BAM) and bile acid-related diarrhea represent an under-recognized cause of chronic diarrhea mainly because of limited guidance on appropriate diagnostic and laboratory tests. We aimed to perform a systematic review of the literature in order to identify and compare the diagnostic accuracy of different diagnostic methods for patients with BAM, despite a proven gold standard test is still lacking. METHODS: A PubMed literature review and a manual search were carried out. Relevant full papers, evaluating the diagnostic accuracy of different methods for BAM, were assessed. Available data were analyzed to estimate the sensitivity and specificity of each published test. RESULTS: Overall, more than one test was considered in published papers on BAM. The search strategy retrieved 574 articles; of these, only 16 were full papers (with a total of 2.332 patients) included in the final review. Specifically, n = 8 studies used 75Selenium-homotaurocholic-acid-test (75SeHCAT) with a < 10% retention threshold; n = 8 studies evaluated fasting serum 7-α-hydroxy-4-cholesten-3-one (C4); n = 3 studies involved total fecal bile acid (BA) excretion over 48 h; n = 4 studies assessed fibroblast growth factor 19 (FGF19). 75SeHCAT showed an average sensitivity and specificity of 87.32 and 93.2%, respectively, followed by serum C4 (85.2 and 71.1%) and total fecal BA (66.6 and 79.3%). Fasting serum FGF19 had the lowest sensitivity and specificity (63.8 and 72.3%). All the extracted data were associated with substantial heterogeneity. CONCLUSIONS: Our systematic review indicates that 75SeHCAT has the highest diagnostic accuracy for BAM, followed by serum C4 assay. The diagnostic yield of fecal BA and FGF19 assays is still under investigation. Our review reinforces the need for novel biomarkers aimed to an objective detection of BAM and therefore improving the management of this condition.
Asunto(s)
Ácidos y Sales Biliares/metabolismo , Síndromes de Malabsorción/diagnóstico , Ácido Taurocólico/análogos & derivados , Biomarcadores/análisis , Humanos , Reabsorción Intestinal/fisiología , Síndromes de Malabsorción/metabolismo , Síndromes de Malabsorción/fisiopatología , Sensibilidad y Especificidad , Ácido Taurocólico/análisisRESUMEN
Candida albicans is a fungal pathogen that poses a significant public health risk due to high incidence and mortality rates among immunocompromised patients. Candida albicans infections begin with successful gastrointestinal (GI) colonization; however, the mechanisms behind this colonization remain to be elucidated. In this study, we investigated the role of taurocholic acid (TCA) on growth and GI colonization of C. albicans. Our results indicate that cefoperazone-treated mice susceptible to C. albicans infection had significantly increased levels of TCA in the gut contents. In addition, an increase in TCA levels directly correlates with higher C. albicans load in the fecal and gut contents of antibiotic-treated infected mice. Using in vitro assays, we also demonstrated that TCA enhances the growth of C. albicans and its ability to develop filamentous hyphae. Furthermore, TCA significantly increased the ability of C. albicans to attach to mammalian cells. These results demonstrate that antibiotic treatment alters TCA levels in the gut and potentially enhances GI colonization of C. albicans.
Asunto(s)
Antibacterianos/efectos adversos , Candida albicans/crecimiento & desarrollo , Candidiasis/inducido químicamente , Cefoperazona/efectos adversos , Colagogos y Coleréticos/análisis , Tracto Gastrointestinal/microbiología , Ácido Taurocólico/análisis , Animales , Antibacterianos/administración & dosificación , Candida albicans/efectos de los fármacos , Cefoperazona/administración & dosificación , Adhesión Celular/efectos de los fármacos , Línea Celular , Recuento de Colonia Microbiana , Modelos Animales de Enfermedad , Heces/microbiología , Humanos , RatonesRESUMEN
UNLABELLED: Gall-stone disease constitutes a serious clinical problem and is the most frequent cause of elective cholecystectomies. There are many etiopatogenic factors however; lithogenic bile and its stasis due to gall-bladder hypomotility seem to be the most important. In recent years discovery of pacemaker function of Interstitial Cells of Cajal changed our understanding of smooth muscle physiology and helped to disclose many gastrointestinal motility disorders. THE AIM OF THE STUDY: was identification and quantification of interstitial Cajal-like cells (ICLCs) in gall-bladder muscle wall from patients with cholelithiasis and in gall-stone-free controls, as well as determination of the relationship between the number of ICLCs and Cholesterol Saturation Index (CSI) of bile in both analyzed groups. MATERIAL AND METHODS: 20 patients operated for symptomatic cholelithiasis were enrolled into the study group. The control group consisted of 20 patients operated for pancreatic head tumors, with no pre- and intraoperative signs of gall-stones. Identification of ICLCs in the gall-bladder was performed by means of double immunofluorescence technique with anti c-Kit and anti-mast cell tryptase antibodies. Quantitative analysis was carried out under fluorescence microscopy conjoined with image analysis software. Bile samples were used for calculation of CSI. RESULTS: ICLCs were detected within gall-bladder muscle wall. Number of ICLCs was statistically significantly lower in patients from the study group as compared to control. The study also revealed statistically significantly higher CSI in the study group. CONCLUSIONS: The quantity of ICLCs is diminished in the gall-bladder from patients with cholelithiasis and there is negative correlation between the number of ICLCs and CSI of bile. Regarding the role of ICCs in regulation of GI tract motility, it appears that reduction in their number may be important etiopatogenic factor of cholelithiasis.
Asunto(s)
Bilis/química , Colelitiasis/patología , Colesterol/análisis , Vesícula Biliar/patología , Células Intersticiales de Cajal/patología , Músculo Liso/patología , Fosfolípidos/análisis , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Ácido Glicocólico/análisis , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Ácido Taurocólico/análisisRESUMEN
BACKGROUND: Quantification of bile acids using LC-MS has previously been very challenging on triple quadrupole MS systems due to the absence of a primary fragment ion for unconjugated bile acids. RESULTS: A LC-high-resolution/accurate mass MS method for the analysis of six bile acids (cholic acid, chenodeoxycholic acid, taurocholic acid, deoxycholic acid, lithocholic acid and ursodeoxycholic acid) was developed and successfully validated. The method includes a single extraction and a single injection with all analytes separated using target-selected ion monitoring (SIM) mode in two periods with a resolution of 70,000 and 140,000, respectively. CONCLUSION: This is the first LC-high-resolution/accurate mass assay fully validated to quantify six bile acids for regulated bioanalysis.
Asunto(s)
Ácidos y Sales Biliares/análisis , Biomarcadores/sangre , Proteínas Sanguíneas/análisis , Cromatografía Liquida/métodos , Espectrometría de Masas en Tándem/métodos , Ácido Quenodesoxicólico/análisis , Ácido Cólico/análisis , Ácido Desoxicólico/análisis , Humanos , Ácido Litocólico/análisis , Sensibilidad y Especificidad , Ácido Taurocólico/análisis , Ácido Ursodesoxicólico/análisis , Estudios de Validación como AsuntoRESUMEN
Olfactory sensitivity to bile salts is wide-spread in teleosts; however, which bile salts are released in sufficient quantities to be detected is unclear. The current study identified bile salts in the intestinal and bile fluids of Solea senegalensis by mass spectrometry-liquid chromatography and assessed their olfactory potency by the electro-olfactogram. The main bile salts identified in the bile were taurocholic acid (342 mM) and taurolithocholic acid (271 mM) plus a third, unidentified, bile salt of 532.3 Da. These three were also present in the intestinal fluid (taurocholic acid, 4.13 mM; taurolithocholic acid, 0.4 mM). In sole-conditioned water, only taurocholic acid (0.31 microM) was released in sufficient quantities to be measured (release rate: 24 nmol kg(-1) min(-1)). Sole had high olfactory sensitivity to taurocholic acid but not to taurolithocholic acid. Furthermore, olfactory sensitivity was higher in the upper (right) olfactory epithelium than the lower (left). These two bile acids contribute about 40% of the olfactory potency of intestinal fluid and account for the difference in potency at the two epithelia. Taurocholic acid (but not taurolithocholic acid), and possibly other types of bile acid not tested, could be used as chemical signals and the upper olfactory epithelium is specialised for their detection.
Asunto(s)
Ácidos y Sales Biliares/análisis , Bilis/química , Peces Planos/fisiología , Contenido Digestivo/química , Percepción Olfatoria/fisiología , Comunicación Animal , Animales , Cromatografía Líquida de Alta Presión , Heces/química , Peces Planos/anatomía & histología , Vesícula Biliar/química , Intestinos/química , Mucosa Olfatoria/fisiología , Receptores Odorantes/fisiología , Agua de Mar/análisis , Umbral Sensorial , Ácido Taurocólico/análisis , Ácido Taurolitocólico/análisisRESUMEN
1H and 13C NMR spectra of intact human bile were assigned using one-dimensional (1H and 13C) and two-dimensional (1H-1H and 1H-13C) experiments. Individual conjugated bile acids--glycocholic acid, glycodeoxycholic acid, glycochenodeoxycholic acid, taurocholic acid, taurodeoxycholic acid, and taurochenodeoxycholic acid--were identified. The bile acids were quantified accurately and individually in a single step by using distinct and characteristic amide signals. Making use of 13C NMR, the study also suggests a way to analyze unconjugated bile acids separately, if present. Chemical shift assignments and rapid single-step analysis of individual conjugated bile acids from intact bile presented herein may have immense utility in the study of bile acid metabolism and deeper understanding of hepatobiliary diseases.
Asunto(s)
Ácidos y Sales Biliares/química , Bilis/química , Resonancia Magnética Nuclear Biomolecular/métodos , Ácido Quenodesoxicólico/análisis , Ácido Glicoquenodesoxicólico/análisis , Ácido Glicocólico/análisis , Ácido Glicodesoxicólico/análisis , Humanos , Modelos Biológicos , Ácido Tauroquenodesoxicólico/análisis , Ácido Taurocólico/análisis , Ácido Taurodesoxicólico/análisisRESUMEN
OBJECTIVE: To provide evidence for three-level prevention of cholelithiasis by means of observing the effects of some choleretics on bile compositions drained from patients with pigment gallstone. METHODS: Twenty-seven patients suffering from primary pigment gallstones and having received treatment of choledochostomies plus T-tube or endoscopic nasal bile drainage (ENBD) were divided equally into three groups, and administered respectively with Lidanling (the LDL group), ursodesoxycholic acid (the UDA group) and combination of LDL and UDA (the LDL + UDA group) through oral intake (7 patients in each group). Besides, 6 post-operational patients got no treatment with any drug were allocated in the control group. Bile of all the patients was collected before treatment and on the 1, 3, 5, 7 th day after the treatment started to detect levels of total bile acid (TBA), glycocholic acid (GCA), taurocholic acid (TCA), glycocholic cheno-desoxycholic acid (GCDCA), total bilirubin (TBIL), uncombined bilirubin (UCB), concentration of calcium ion (Ca(2+)) as well as the bacterio-genetic and endogenous beta-glucuronidase activity for comparing. RESULTS: Levels of TBA, GCA, TCA and GCDCA got gradually increased in the UDA group and the LDL + UDA group after treatment (P < 0.05), while those in the LDL group remained unchanged, showing an insignificant difference as compared with those in the control group. In the LDL group and the LDL + UDA group, TBIL gradually increased while UCB gradually decreased in the course of treatment (P < 0.05). Moreover, levels of Ca(2+) and endogenous beta-glucuronidase activity got significantly lowered (P < 0.05). CONCLUSION: Combined use of LDL and UDA could elevate levels of TBA, GCA, TCA, GCDCA, enhance the excretion of TBIL in patients with pigment gallstone after bile drainage, lower levels of UCB and Ca(2+) and the activity of endogenous beta-glucuronidase in the bile, so as to reduce the possibility of stone formation of bile, and therefore, it could be used to prevent the production of pigment gallstone, especially to prevent post-operative recurrence of stones.
Asunto(s)
Bilis/química , Colagogos y Coleréticos/farmacología , Medicamentos Herbarios Chinos/farmacología , Cálculos Biliares/metabolismo , Adulto , Ácidos y Sales Biliares/análisis , Bilirrubina/análisis , Calcio/análisis , Coledocostomía , Ácido Cisteico/análogos & derivados , Ácido Cisteico/farmacología , Drenaje , Medicamentos Herbarios Chinos/uso terapéutico , Femenino , Glucuronidasa/análisis , Ácido Glicocólico/análisis , Humanos , Masculino , Persona de Mediana Edad , Ácido Taurocólico/análisis , Ácido Ursodesoxicólico/análogos & derivados , Ácido Ursodesoxicólico/farmacologíaRESUMEN
The use of a Q-q-Q(linear ion trap) instrument to obtain product ion spectra is described. The instrument is based on the ion path of a triple quadrupole mass spectrometer with Q3 operable as either a conventional RF/DC quadrupole mass filter or a linear ion trap mass spectrometer with axial ion ejection. This unique ion optical arrangement allows de-coupling of precursor ion isolation and fragmentation from the ion trap itself. The result is a high sensitivity tandem mass spectrometer with triple quadrupole fragmentation patterns and no inherent low mass cut-off. The use of the entrance RF-only section of the instrument as accumulation ion trap while the linear ion trap mass spectrometer is scanning enhances duty cycles and results in increased sensitivities by as much as a factor of 20. The instrument is also capable of all of the triple quadrupole scans including multiple-reaction monitoring (MRM) as well as precursor and constant neutral loss scanning. The high product ion scanning sensitivity allows the recording of useful product ion spectra near the MRM limit of quantitation.
Asunto(s)
Espectrometría de Masas/instrumentación , Preparaciones Farmacéuticas/análisis , Alprazolam/análisis , Indicadores y Reactivos , Naproxeno/análisis , Estándares de Referencia , Reproducibilidad de los Resultados , Reserpina/análisis , Ácido Taurocólico/análisisRESUMEN
The gallbladder role in cholesterol gallstone pathogenesis occurs through modulation of bile cholesterol metastability. The present study characterized the effects of concentrating bile on cholesterol crystallization through vesicle transformation, crystal habits, and potentiation of effector substances. Supersaturated model biles with total lipid concentrations of 12, 9, 6, and 3 g/dl were prepared with identical molar ratios (taurocholate-egg yolk phosphatidylcholine-cholesterol: 71:18:11). Bile metastability was assessed spectrophotometrically, and morphology of vesicle and crystal was sequentially scanned by video-enhanced differential contrast microscopy. The effects of replacing 30% of egg yolk phosphatidylcholine with soy bean phosphatidylcholine, 30% of taurocholate with taurodeoxycholate or tauroursodeoxycholate, and addition of concanavalin A-binding glycoprotein on each model bile were examined. By lowering total lipid concentration, cholesterol crystallization was retarded with less fusion and aggregation of vesicles. The effects of substances promoting cholesterol crystallization were enhanced with lesser bile. By replacing 30% of taurocholate with tauroursodeoxycholate, cholesterol crystallization was markedly inhibited in all concentrations, forming stable liquid-crystals. Impaired water absorption by the gallbladder may stabilize vesicles and inhibit rapid cholesterol crystallization, but the potential of cholesterol crystallization effector substances must be modified to alter bile cholesterol metastability.
Asunto(s)
Bilis/química , Colesterol/análisis , Vesícula Biliar/fisiología , Cristalización , Humanos , Lípidos/análisis , Microscopía por Video , Modelos Biológicos , Tamaño de la Partícula , Fosfatidilcolinas/análisis , Espectrofotometría , Ácido Taurocólico/análisis , Ácido Taurodesoxicólico/análisisRESUMEN
Steroid metabolism along the gastrointestinal tract of the cannulated pig was studied. Thi was achieved by fitting simple gut cannulas in the terminal ileum, caecum and mid-colon of three Landrace x large white boars, which enabled convenient collection of digesta and faecal samples at defined time points. Biochemical analyses showed that the neutral steroid profile of the pig is similar to that of man, dominated by cholesterol and its bacterial metabolite coprostanol. In contrast, pigs consuming a normal diet excrete appreciably lower quantities of neutral sterols in faeces. The major primary bile acids detected were the glycine and taurine amidates of hyocholic and chenodeoxycholic acids, which were rapidly converted to the free bile acids and subsequently dehydroxylated to hyodeoxycholic and lithocholic acids respectively, in the terminal ileum and caecum. Bacterial deconjugation and 7 alpha-dehyrdoxylation are virtually complete in the caecum with negligible further metabolism in the colon and faeces. On a wet weight basis the concentration of both neutral and acid steroids was shown to increase aborally. Inclusion of dietary fibre in the form of cellulose (Solka floc) and guar gum reduced steroid concentration considerably at all sites of the large intestine, which is consistent with their stool bulking effects. In conclusion, this study shows that intestinal steroid metabolism in the pig is similar to that in man despite slightly different bile acid profiles and, therefore, the multicannulated pig may serve as a useful model of man in chemoprevention studies of colorectal cancer.
Asunto(s)
Mucosa Intestinal/metabolismo , Esteroides/metabolismo , Animales , Bacterias/metabolismo , Ácidos y Sales Biliares/análisis , Cateterismo , Ciego/metabolismo , Celulosa/metabolismo , Colestanol/análisis , Colesterol/análisis , Colon/metabolismo , Fibras de la Dieta/metabolismo , Modelos Animales de Enfermedad , Heces/química , Galactanos/metabolismo , Contenido Digestivo/química , Ácido Glicoquenodesoxicólico/análisis , Ácido Glicocólico/análisis , Ácido Glicodesoxicólico/análisis , Humanos , Íleon/metabolismo , Intestinos/microbiología , Masculino , Mananos/metabolismo , Gomas de Plantas , Esteroides/análisis , Esteroles/análisis , Porcinos , Ácido Tauroquenodesoxicólico/análisis , Ácido Taurocólico/análisis , Ácido Taurodesoxicólico/análisis , Ácido Taurolitocólico/análisisRESUMEN
Hepatic bile synthesis is altered during experimental gallstone formation. In response to cholesterol, there is a hydrophobic shift in hepatic bile acid synthesis and hypersecretion of phospholipids. These changes decrease the vesicular capacity for cholesterol and favor crystallization. The mechanism for these changes in hepatic bile formation is unknown. Calmodulin (CaM), a Ca2+ receptor protein involved in cellular secretion, regulates gallbladder transport and may play an important role in alterations of hepatic bile formation during cholelithiasis. We hypothesized that biliary CaM activity is altered during gallstone formation and may be associated with changes in bile acid and phospholipid synthesis. Prairie dogs were fed either control (N = 22) or 1.2% cholesterol-enriched (N = 26) diets for one to six weeks. Cholecystectomy was performed; the common bile duct was cannulated, and hourly bile samples were collected. CaM was measured in bile and gallbladder tissues by radioimmunoassay. Bile samples were analyzed for cholesterol, phospholipids, total bile acids, total protein, calcium, and individual bile acid composition. Compared to controls, gallstone animals had elevated hepatic bile levels of CaM, phospholipids, and cholesterol. Hydrophobic bile acid synthesis was also stimulated, with increased levels of taurochenodeoxycholic acid (TCDCA) and decreased taurocholic acid (TCA). Gallbladder bile demonstrated similar changes. Although gallbladder bile CaM levels were increased, tissue levels were unchanged, suggesting that increased CaM concentration is a hepatic phenomenon. Hepatic bile CaM activity correlated linearly with TCDCA concentration (r = 0.64, P < 0.004) and phospholipid hypersecretion (r = 0.53, P < 0.03). The relationship between biliary CaM and increased concentrations of TCDCA and phospholipids suggests a role for CaM in alterations of hepatocyte secretion that may promote gallstone formation.
Asunto(s)
Bilis/química , Calmodulina/análisis , Colelitiasis/metabolismo , Animales , Colesterol/análisis , Vesícula Biliar/metabolismo , Hígado/metabolismo , Masculino , Fosfolípidos/análisis , Sciuridae , Ácido Taurocólico/análisisRESUMEN
Gallbladder contents from 8 active and 14 dormant black bears were analyzed for individual bile acids by high-performance liquid chromatography and for cholesterol, phospholipids, sodium, potassium, calcium, magnesium, zinc, iron, and copper. Only three bile acids occurring as taurine conjugates were detected: tauroursodeoxycholate, taurochenodeoxycholate, and taurocholate. The proportion of tauroursodeoxycholate to the sum of the three bile acids decreased. Calcium, cholesterol, phospholipids, magnesium, zinc, and copper concentrations were increased in dormancy. Standardized collection and handling procedures yielded more consistent data than previously available. The decrease in tauroursodeoxycholate and absence of deoxycholate and lithocholate are consistent with our working hypothesis that a marked reduction in metabolic activity of the gut flora is an integral part of the adaptation to metabolic stability of the dormant bear.
Asunto(s)
Bilis/química , Vesícula Biliar/metabolismo , Metales/análisis , Estaciones del Año , Ursidae/metabolismo , Animales , Ácidos y Sales Biliares/análisis , Calcio/análisis , Colesterol/análisis , Cobre/análisis , Hibernación , Hierro/análisis , Magnesio/análisis , Fosfolípidos/análisis , Potasio/análisis , Sodio/análisis , Ácido Tauroquenodesoxicólico/análisis , Ácido Taurocólico/análisis , Zinc/análisisRESUMEN
The absorption of three retinoid analogs etretinate (ET), acitretin (ETA), and motretinid (MOE) from two distinct micellar systems was studied in the rat intestine. Each of the three drugs was loaded into simple micelles consisting of 10 mM sodium taurocholate (NaTC) and mixed micelles consisting of 10 mM egg phosphatidylcholine (PC) and 10 mM NaTC. Following perfusion through the jejunum segments, both the fraction of drug disappearing from the segment and the permeability of the drug from the lumen into the gut wall (Peff) was greater with the mixed micelles as compared to the simple micelles. Perfusion flow rate had an influence on the Peff for ET and ETA. Similar trends as for the jejunum were seen in the ileum perfusions. The simultaneous uptake of PC and NaTC during the retinoid perfusions was monitored. There appeared to be a correlation between the Peff values for PC and that of the retinoids. The viability of the in-situ perfusion system was confirmed histologically. There is evidence to indicate that the permeability of the intestine is sensitive to subtle differences in the chemical structure of the retinoids.
Asunto(s)
Absorción Intestinal/fisiología , Retinoides/farmacocinética , Animales , Cromatografía Líquida de Alta Presión , Técnicas In Vitro , Masculino , Micelas , Permeabilidad , Ratas , Ratas Sprague-Dawley , Retinoides/química , Espectrofotometría Ultravioleta , Ácido Taurocólico/análisisRESUMEN
Bile salts initially self-associate into small aggregates such as dimers and trimers before forming micelles at higher concentrations. The very size of these small aggregates hampers quantitation of their formation. We have devised a method using kinetic dialysis measurements to quantitatively examine aggregation of bile salt at concentrations below 10 mM. Data for rate of dialysis versus concentration were fitted to hypothetical models of aggregation using a personal computer spreadsheet. For sodium taurocholate these data best fit a model of initial dimer and trimer formation with stepwise association constants of 100 and 160, respectively. Addition of larger aggregates to the model did not improve the fit. For sodium taurodeoxycholate the data best fit a model which included not only dimers and trimers, but also tetramers or larger aggregates up to 10-mers with stepwise association constants of 40, 400, and 1700 for dimers, trimers, and tetramers, respectively. These data agree reasonably well with existing literature and suggest that kinetic dialysis with spreadsheet modeling is a useful technique for the study of bile salt aggregation at relatively low concentrations.
Asunto(s)
Ácidos y Sales Biliares/análisis , Ácidos y Sales Biliares/química , Diálisis , Cinética , Luz , Sustancias Macromoleculares , Micelas , Modelos Químicos , Dispersión de Radiación , Programas Informáticos , Ácido Taurocólico/análisis , Ácido Taurocólico/químicaRESUMEN
Total and individual bile acid concentrations in the oesophageal aspirates from 30 patients with Barrett's oesophagus were compared with those from 15 patients with oesophagitis and 15 normal subjects. The highest total bile acid concentrations were found in the Barrett's patients and this was statistically significant when compared with controls but not oesophagitis patients. However, when the 95th percentile value of bile acid concentration in the normal subjects was taken as the 'cut-off' level, a significantly higher number of Barrett's patients (15/30) were bile refluxers than were the oesophagitis patients (3/15). Glycocholic and taurocholic acids were the predominant bile acids detected, but taurochenodeoxycholic acid was also present in significant amounts in the patients with oesophagitis. It is possible that bile reflux contributes to the development of Barrett's oesophagus.
Asunto(s)
Esófago de Barrett , Ácidos y Sales Biliares/análisis , Reflujo Gastroesofágico , Anciano , Esófago de Barrett/complicaciones , Ingestión de Alimentos , Femenino , Reflujo Gastroesofágico/etiología , Ácido Glicocólico/análisis , Humanos , Masculino , Persona de Mediana Edad , Postura , Ácido Taurocólico/análisisRESUMEN
In order to evaluate the effect of cholecystectomy on the gastric mucosa, the duodenogastric reflux of total and single bile acids, the number of parietal and gastrin cells, and the volume of gastric acid secretion were examined in 15 patients with gallstones and functioning gallbladders before and 6 months after cholecystectomy. The duodenogastric reflux of the total bile acids increased from a mean preoperative value of 1.9 mumol/hour to a mean postoperative value of 21 mumol/hour (p = 0.008). The duodenogastric reflux of all single bile acids increased after cholecystectomy, with a higher increase in glycoconjugated compared with tauroconjugated bile acids. The parietal cells decreased from a mean preoperative value of 82.8 to a mean postoperative value of 68.7 (p = 0.05), whereas there was only a mild increase in the number of gastrin cells; the output of gastric acid remained unchanged. The variation of the gastrin cells before and after cholecystectomy was negatively correlated only with the variation of taurocholic acid (r = -0.50, p = 0.05), while the variation of the parietal cells was mildly correlated with all single bile acids (r = 0.35-0.50, 0.05 less than p less than 0.02). These findings show an increased duodenogastric reflux of bile acids 6 months after cholecystectomy with a mild morphologic alteration of the gastric mucosa.
Asunto(s)
Ácidos y Sales Biliares/análisis , Colecistectomía , Reflujo Duodenogástrico , Ácido Gástrico/metabolismo , Gastrinas/análisis , Células Parietales Gástricas/citología , Adulto , Anciano , Colelitiasis/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Ácido Taurocólico/análisis , Factores de TiempoRESUMEN
To determine whether in complete obstructive cholestasis taurocholate is taken up by hepatocytes and if so whether it is secreted into bile, tritium-labelled taurocholate was localized by histoautoradiography on cryoslices from normal rat livers and from those after bile duct ligation. In non-cholestatic livers the hepatocytes of acinar zones 1 as well as the lumina and the epithelia of bile ductules and ducts became intensely labelled directly after injection of [3H]taurocholate into a mesenterial vein. Four hours and 4 days after bile duct ligation, hepatocytes of all three acinar zones became labelled, but in contrast to the normal state, pericanalicular concentration of silver grains was not observed, not even within 5 min. Fifteen days after bile duct obstruction, cryoslices taken 2 min after injection of [3H]taurocholate exhibited an intense silver grain labelling of all acinar zones, with the highest density at bile canalicular areas of the liver cell plates as well as the proliferated bile ductules and bile ducts. The biliary epithelium of small bile ductules and ducts of non-cholestatic and of bile duct-obstructed livers were also covered with silver grains; the epithelium of larger ducts exhibited significant labelling predominantly at the lateral sites of the cells. The biliary epithelium of the common bile duct was not significantly labelled. The results indicate that in complete obstructive cholestasis (a) taurocholate continues to be taken up from blood by hepatocytes and secreted into bile, but in terms of varying duration of obstruction, (b) all acinar zones are involved in bile salt transport, (c) in the initial phase (4 h and 4 days respectively after bile duct obstruction) hepatocytes fail to concentrate taurocholate at the canalicular site, (d) in a consecutive phase, in which bile ductules and ducts proliferate (demonstrated for a 15-day cholestasis), the taurocholate concentration at the canalicular site of hepatocytes is re-established and biliary secretion seems to be enhanced, (e) the biliary epithelium of bile ductules and ducts may play a significant role in the reabsorption and/or regurgitation of bile salts from bile to blood. Reabsorption/regurgitation of biliary constituents may also be operative in the non-cholestatic state but may become significantly enhanced with bile ductular proliferation.
Asunto(s)
Colestasis/metabolismo , Hígado/análisis , Ácido Taurocólico/análisis , Animales , Autorradiografía , Conductos Biliares , Ligadura , Masculino , Ratas , Ratas Endogámicas , Ácido Taurocólico/metabolismoRESUMEN
The effect of streptozotocin (SZ) administration on sodium [14C]taurocholate (TC) transmural transfer was studied in the everted rat ileum. The excretion of fecal bile acids was also studied in living rats injected with that compound. The viability of the preparation used for the in vitro experiments was evaluated by light microscopy and by the rate of glucose uptake by tissue from the mucosal fluid. The results obtained showed that TC transfer to the serosal fluid was impaired after 24 h of SZ injection, as well as the active transport observed in control preparations. The amount of TC accumulated in the intestinal tissue was also diminished. In addition, total ATPase activity of tissue was decreased, and intracellular electrolyte concentration was altered. Therefore, a slower saturation of binding sites could be responsible for the effects of SZ on TC tissue accumulation, and a decreased ATPase activity for the impairment of the TC concentrative transport system. The results observed in vitro were supported by data in vivo because fecal bile acid excretion was significantly diminished in SZ-treated rats.