1. Fasting concentrations of C, CD and D were determined in systemic and portal venous serum in
gallstone patients and controls (patients with
adenomyoma of the gallbladder) undergoing
cholecystectomy. No differences were observed between the two groups either in systemic or portal serum concentrations of the
bile acids or in their hepatic uptake. Ketonic
bile acid concentrations amounted to 9% and 8% of the non-oxidized
bile acids in the systemic and portal circulation, respectively. 2. Fasting systemic and portal venous serum concentrations of
bile acids were measured in
gallstone patients fed with C and CD prior to
cholecystectomy. Treatment with CD increased the total portal inflow of
bile acids by 60%, whereas C treatment did not alter this total inflow compared with controls. This difference may partly explain why hepatic bile is unsaturated during treatment with CD, but not with C. 3. The postprandial concentrations of
bile acids were determined in the systemic and portal venous circulation in cholecystectomized patients. The systemic venous
bile acid level reflected the portal venous level. The estimated hepatic uptake of the individual
bile acids was highly efficient and could not be saturated during maximal physiological portal inflow to the liver. The existence of a lymphatic transport of
bile acids, calculated to correspond to about 0.2% of the portal transport, was demonstrated in four patients undergoing
renal transplantation. 4.
Cholestyramine treatment was shown to reduce the plasma
cholesterol level in patients with familial hypercholesterolaemia without lowering the fasting systemic level of total
bile acids. Nor did this treatment reduce the fasting portal inflow of total
bile acids. The total
bile acid concentration in healthy volunteers during treatment showed a 40% reduction postprandially, but not in the fasting state, indicating that the effect of
cholestyramine on hepatic
cholesterol metabolism is the consequence of a reduced postprandial inflow of portal
bile acids. The effects of the loss of the active site of
bile acid absorption on the postprandial serum
bile acid pattern were studied in patients with ileal resections. In general, the postprandial response of C was reduced whereas that of CD remained less affected.