The Biliary Excretion of Sulphated and Non-Sulphated Bile Acids and Bilirubin in Patients with External Bile Drainage

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Abstract
The biliary excretion of total bilirubin and bile acids and the fate of tracer doses of radioactive sulfated and non-sulfated bile acids were studied in patients with percutaneous transhepatic bile drainage. Non-sulfated bile acids were excreted in bile early after biliary decompression and the serum total 3.alpha.-hydroxy bile acid concentrations fell rapidly to normal. Biliary bilirubin excretion was both less than and delayed compared wtih that of bile acids and the serum bilirubin concentration fell more slowly. The serum disappearance of [3H] chenodeoxycholate-3- sulfate was slower than that of [14C]glycocholate in all patients with bile drainage, the difference being more marked in the jaundiced patients. The radioactive sulfated bile acids were recovered predominantly in the urine of the jaundiced patients. In contrast [14C]glycocholate was excreted almost exclusively in bile. In an anicteric patient, radioactive sulfated bile acid disappeared from the serum more quickly and biliary recovery exceeded that in the urine. Differences in handling of total bilirubin, and sulfated and non-sulfated bile acids in man after the relief of bile duct obstruction are thus demonstrated. The biliary excretion of radioactive labeled sulfated bile acids is low for at least 1 wk after biliary drainage, but later becomes the predominant route for excretion in the anicteric patient.