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Updated: Jan 16, 2026

Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport
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Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport

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Altered Serum Bile Acid Pattern as an Independent Factor for Covert and Overt Hepatic Encephalopathy in Patients With

Takao Miwa1, Hajime Ueda2, Teruo Miyazaki2

  • 1Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan.

Hepatology Research : the Official Journal of the Japan Society of Hepatology
|September 27, 2025
PubMed

Insights

High bile acid (BA) levels impact liver disease. Elevated conjugated primary BAs predict overt hepatic encephalopathy (HE) and mortality in cirrhosis patients, while non-conjugated BAs indicate covert HE.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Biochemistry

Background:

  • Bile acid (BA) signaling is implicated in hepatic encephalopathy (HE) pathogenesis.
  • Clinical impact of BA signaling in cirrhosis patients, especially for covert HE (CHE) and overt HE (OHE), remains understudied.

Purpose of the Study:

  • To investigate the clinical significance of BA levels in cirrhosis patients.
  • To assess the association between BA levels and the development of CHE, OHE, and mortality.

Main Methods:

  • Retrospective study of 189 cirrhosis patients with CHE assessment.
  • Quantification of BAs using liquid chromatography-tandem mass spectrometry.
  • Statistical analysis including logistic, Fine-Gray competing risk, and Cox regression models.

Main Results:

  • 28.0% of patients had CHE; 15.9% developed OHE and 33.3% died during follow-up.
  • High conjugated primary BA levels independently predicted OHE development (aHR 3.44) and mortality (HR 2.06).
  • High non-conjugated primary BA levels independently predicted CHE (OR 2.18).

Conclusions:

  • Elevated serum conjugated primary BA levels are independent predictors of OHE and mortality in cirrhosis.
  • Elevated non-conjugated primary BA levels are associated with CHE in cirrhosis patients.
Abstract

Keywords:
covert hepatic encephalopathygut‐liver axismicrobiomeminimal hepatic encephalopathymortalitysurvival

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