[Amounts, synthesis and turnover of sulfated and non-sulfated bile acids in patients with cholestasis].
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Bile Acids and Salts↗
Biomedical subjects
R Raedsch
Publications and source records attributed to R Raedsch.
Increased sulfation of lithocholate in patients with cholesterol gallstones during chenodeoxycholate treatment.
Chenodeoxycholate was administered to 13 patients with cholesterol gallstones. During the treatment period the bile composition changed markedly. Chenodeoxycholate increased from 42.9% of the total bile salts before treatment to 79.3% after 8 weeks of treatments. Ursodeoxycholate increased from 2.3 to 12.6% and lithocholate from 1.1 to 3.3%. In contrast, cholate decreased from 40.3% of the total bile salts to 3.1% and deoxycholate decreased from 12.5 to 2.5%. Less than 5% of chenodeoxycholate, ursodeoxycholate, cholate and deoxycholate in bile were sulfate esters. In contrast, considerable amounts of lithocholate were sulfated. The sulfation of lithocholate increased from 32.8% of the total lithocholate before treatment to 73.9% after 8 weeks of treatment. Sulfated lithocholate is more rapidly eliminated in feces and urine than the nonsulfated compound. Furthermore, sulfated lithocholate is less toxic. Therefore, the increase in the sulfation of lithocholate observed in most of our patients represents a protective mechanism.
Aged↗
[Increasing sulfatization of lithocholic acid during chenodeoxycholic acid treatment].
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Chenodeoxycholic Acid↗
Effect of ursodeoxycholic acid on biliary bile acid and bile lipid composition in gallstone patients.
In five patients with radiolucent gallstones, the effect of ursodeoxycholic acid (Urso) in doses of 250, 500, 750, 1,000, and 1,250 mg per day on biliary lipid and bile acid composition was studied. Biliary cholesterol decreased from 8.8 +/- 0.8 mole% to 4.4 +/- 0.2 mole% at 500 mg Urso per day (7.1 mg per kg) and to 4.2 +/- 0.3 mole% at 750 mg Urso per day (10.7 mg per kg). Administration of 1,000 or 1,250 mg Urso per day produced no further decrease of biliary cholesterol. The biliary content of phospholipids and total bile acids remained unchanged. During Urso treatment, the relative amounts of glyco-Urso and tauro-Urso in bile increased. Glyco-Urso reached a plateau at 49.1 +/- 2.1% of total bile acids during treatment with 1,000 mg Urso per day, and tauro-Urso increased up to 4.3 +/- 1.5% of total bile acids at 250 mg Urso per day. Simultaneously cholic acid, chenodeoxycholic acid, deoxycholic acid, and lithocholic acid decreased. The data indicate that Urso treatment reduces biliary cholesterol efficiently already at a dose of 500 mg per day; biliary bile acid composition changes up to 1,000 mg Urso per day. Doses greater than 1,000 mg per day produced no additional alterations in bile composition.
Aged↗
Biliary and urinary excretion of sulfated, glucuronidated and tetrahydroxylated bile acids in cirrhotic patients.
In patients with hepatobiliary diseases, considerable amounts of sulfated and glucuronidated bile acids are excreted in urine. Information on the biliary excretion of these compounds is lacking. We used an intestinal perfusion method to determine the biliary excretion of sulfated and glucuronidated bile acids in eight patients with alcoholic cirrhosis and moderately severe cholestasis and compared results with urinary excretion rates. In bile, the patients excreted 508.7 mumoles per hr (mean) nonsulfated, nonglucuronidated bile acids, 8.1 mumoles per hr sulfated bile acids and 4.0 mumoles per hr glucuronidated bile acids. In urine, these patients excreted 0.27 mumoles per hr nonsulfated, nonglucuronidated bile acids, 0.88 mumoles per hr sulfated bile acids and 0.02 mumoles per hr glucuronidated bile acids. Sulfates and glucuronides of mono-, di- and trihydroxy bile acids were detected in urine and bile. In urine, tetrahydroxy bile acids were only excreted as nonsulfated and nonglucuronidated forms. The bile:urine excretion ratio of sulfated bile acids was 9:1 and of glucuronidated bile acids was 226:1. In alcoholic cirrhosis with cholestasis, biliary excretion is an important excretory route of sulfated and glucuronidated bile acids.
Adult↗
Terlipressin in bleeding esophageal varices: a placebo-controlled, double-blind study.
The effect of terlipressin (N-alpha-triglycyl-8-lysine-vasopressin) in bleeding esophageal varices was evaluated in a prospective placebo-controlled study. Fifty bleeding episodes from esophageal varices in 34 patients were randomized. Standard therapy with transfusions, fluid and electrolyte correction, and lactulose was performed in both groups. Balloon tamponade was used in 20 bleeding episodes in the terlipressin group and in 19 bleeding episodes in the control group. In the terlipressin group, hemorrhage was controlled in all bleeding episodes (25/25) whereas in the placebo group, only 20 of 25 bleeding episodes could be stopped within 36 hr (p less than 0.05). Sclerotherapy was performed in five bleeding episodes in the terlipressin group and in seven bleeding episodes in the placebo group. Treatment failures, including patients who required sclerotherapy, occurred in five bleedings in the terlipressin group and in 12 in the control group (p less than 0.05). The hospital mortality rate was 12% (3/25) in the terlipressin group and 32% (8/25) in the control group. Patients in the terlipressin group required fewer transfusions, the balloon needed to be inflated for a shorter time and the duration of bleeding was shorter than in the control group. However, these differences were not significant. These data do not allow conclusions concerning monotherapy with terlipressin, but they indicate that the addition of terlipressin to standard therapy may increase the control rate in acute variceal hemorrhage.
Adult↗
Biliary lipids, lithogenic index and biliary drug concentrations during etofibrate and bezafibrate treatment.
Hypolipidemic drugs like etofibrate and bezafibrate may induce lithogenic bile and increase the risk of gallstone formation. In this study, biliary lipids, lithogenic index and biliary drug concentrations were investigated in 6 hyperlipidemic patients after cholecystectomy. Patients were treated once daily for 5 days with either 500 mg/day etofibrate or 400 mg/day bezafibrate. Hepatic bile was collected for 6 days via T-drainage in 4 hourly aliquots. In the patients treated with etofibrate, the range of the lithogenic index remained stable with 0.89-1.69 before and 0.78-1.51 after 5 day drug therapy. In the bezafibrate group, the range of the lithogenic index rose from 0.81-1.40 to 1.26-1.66 mainly as a result of an increase of biliary cholesterol concentrations. Biliary drug concentrations were substantially higher under bezafibrate treatment than under etofibrate treatment. In conclusion, the fibrate drugs, etofibrate and bezafibrate, are different with regard to lithogenicity of bile and extent of biliary excretion. The safety profile of etofibrate may be preferably compared to other fibrate drugs.
Adult↗
Micronuclei in esophageal cells of Chinese youths in a high-incidence area for esophageal cancer in China.
An epidemiologic survey among 538 young persons between 15 and 26 years of age in a high-risk area for esophageal cancer in the People's Republic of China revealed a high prevalence of esophagitis. Histologically confirmed very mild, mild, and moderate esophagitis was observed in 31.6%, 10.7%, and 1.1% of 354 male and 30.4%, 4.3%, and 1.1% of 184 female subjects. The prevalence of micronuclei in esophageal smears was assayed in a subsample to investigate its possible association with esophagitis and with risk factors for esophageal lesions. Of the 186 subjects, 2.7% had mild or moderate esophagitis, 19.9% had very mild esophagitis, and 77.4% were normal. The frequency distribution of micronucleated cells in the esophageal mucosa was similar for the three diagnostic groups. Mean percentages of micronucleated cells did not differ by diagnosis of esophagitis, household status, current smoking status, presence of oral leukoplakia, or consumption of burning hot beverages or fresh fruit. Higher mean percentages were observed in the older age group of both sexes, but the difference was not statistically significant. The results suggest that if esophagitis is considered an important precursor state in the development of esophageal cancer, the scoring of micronuclei does not appear to be an efficient test for mild forms of esophagitis.
Adolescent↗
Treatment of active and postactive ileal and colonic Crohn's disease with oral pH-modified-release budesonide. German Budesonide Study Group.
BACKGROUND/AIMS: Budesonide is a glucocorticoid with a high topical anti-inflammatory but low systemic activity due to its rapid hepatic inactivation. The aim of this open, multicenter study was to investigate efficacy and safety of oral pH-modified-release budesonide in patients with active Crohn's disease of the ileum and colon and in maintaining budesonide-induced remission in postactive Crohn's disease. MATERIALS AND METHODS: 81 patients (intention-to-treat) received 3 x 3 mg budesonide/day for 6 weeks, followed by 3 x 2 mg budesonide for another 6 weeks in case of response to initial treatment. Clinical and laboratory parameters were assessed at study entry as well as after 2, 4, 6 and 12 weeks of treatment. RESULTS: On an intention-to-treat basis remission was induced in 54.3% of 81 patients with active Crohn's disease, 71.4% of 35 patients stayed in remission after the acute-phase treatment until the end of the trial. Typical steroid-related side effects were observed during the acute-phase treatment in only 18% of the patients. Duration, severity and extent of disease at study entry played no significant role in the outcome of the trial, but there was a tendency towards better results during the acute-phase treatment in patients with moderate disease activity and affection of the terminal ileum and proximal colon. CONCLUSIONS: Budesonide could be an alternative to conventional steroid treatment in patients with active Crohn's disease.
Administration, Oral↗