Assessment of Activity in Chronic Active Liver Disease

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Abstract
Serum conjugates of cholic acid were determined by radioimmunoassay and compared with conventional tests in 38 patients during the course of chronic active liver disease that responded to treatment; 16 patients subsequently relapsed when treatment was discontinued. At the time of diagnosis, values for these bile acids were always significantly elevated. At biochemical resolution of conventional liver tests, the values were still elevated in 33 of 38 patients, and this finding correlated well with evidence of continuing histologic activity. At histologic remission of disease activity, these values were less than twice the upper limit of normal in all 22 patients who subsequently remained in remission without treatment, but were significantly higher in nine of 16 who later relapsed. During relapse, serial determinations showed that elevation of serum conjugates of cholic acid preceded an increased glutamic oxalacetic transaminase. Serum concentrations of these bile acids in chronic active liver disease during and after therapy appear to provide a more sensitive indication of active hepatitis than conventional liver tests. (N Engl J Med 290:1399–1402, 1974)