SERUM BILE-ACIDS AND CHOLESTASIS IN ALCOHOLIC HEPATITIS - RELATIONSHIP WITH USUAL LIVER TESTS AND HISTOLOGICAL FEATURES

Cholestasis is a biochemical and/or histological feature observed in some patients with alcoholic liver disease and is mainly related to alcoholic hepatitis. Accumulation of bile acids in the liver could be pathogenic in alcoholic hepatitis. The aim of this study was to assay serum bile acids in patients with alcoholic hepatitis and to assess the relationship between these parameters, the usual liver tests and the histological features of alcoholic hepatitis. Thirty-six patients (median 51 years, 19 females and 17 males) with biopsy-proven alcoholic hepatitis were included in the study. Cirrhosis was present in 27 patients. Serum bile acids were assayed by high performance liquid chromatography. Three histological scores (alcoholic hepatitis, fibrosis, and cholestasis) were established on each liver sample by two independent pathologists. Serum bile acid concentrations were increased in 35 patients (97%). The median concentration of total serum bile acids was 41.6 mu mol/l (range 3-293), with an increase in primary bile acids (95.7% of total bile acids), mainly chenodeoxycholic acid (median 27.5 mu mol/l, range 3-184). In contrast, serum bilirubin levels were increased in only 26 patients (72%). Histological cholestasis was present in 14 patients (38%). There was no significant correlation between the alcoholic hepatitis and cholestasis scores (r=0.01, p=0.9). A significant correlation was noted between the alcoholic hepatitis score and serum total bile acid (r=0.34, p=0.04), cholic acid (r=0.38, p=0.03) and chenodeoxycholic acid (r=0.32, p=0.05) levels. No correlation was noted between serum bile acid levels and cholestasis (r=0.13, p=0.4) or fibrosis scores (r=0.12, p=0.5). Conversely, the bilirubin level was correlated with the cholestasis score (r=0.40, p=0.02), but not with the alcoholic hepatitis (r=0.10, p=0.5) or fibrosis scores (r=0.17, p=0.31). This study suggests that the histological lesions of alcoholic hepatitis could be related, in part, to an increase in primary bile acids. Further studies are required to assess the effect of ursodeoxycholic acid as a treatment for alcoholic hepatitis. (C) Journal of Hepatology.