Bile acids in the diagnosis, pathology, and therapy of hepatobiliary diseases

Bile acids are normally confined in the enterohepatic circulation in which they play an important role in bile formation, biliary lipid excretion, and intestinal lipid absorption. In hepatobiliary diseases, bile acids escape the confinement of the enterohepatic circulation, allowing the measurement of the serum total bile acid concentration as a diagnostic indicator. Accumulation of certain bile acids within the hepatocyte, amplified as a consequence of cholestatic hepatobiliary disease, probably enhances cytotoxicity and leads to secondary pathology. Ursodeoxycholate, a bile acid with atypical physiological effects, may be useful in the treatment of various long-term cholestatic hepatobiliary diseases. Presently, most of the information on the toxicity and therapeutic usefulness of bile acids are based on studies in humans and experimental animals. Further studies, both basic and clinical, are needed to determine the pathologic as well as the therapeutic effects of bile acids in domestic animals.