METABOLISM OF LITHOCHOLIC ACID IN BILE FISTULA PATIENTS*

Abstract

Analysis of the biliary end products of intravenously administered 24-Cl4-lithocholic acid in 2 patients with complete external biliary fistulas permitted the following observations. Over 90% of the radioactivity excreted in the bile was recovered as conjugated lithocholic acid, indicating that this bile acid is not transformed by the human liver to other compounds to any appreciable extent. Very small quantities (2 to 3%) of this acid, however, can be converted to other bile acids by the human liver. Lithocholic acid and deoxycholic acid are not present in the bile of patients in whom bile is excluded from the intestine. Free bile acids (unconjugated with taurine or glycine) can be excreted into the bile in small quantities by the human liver. Transintestinal excretion of bile acids, if it occurs at all, is not a quantitatively important route for elimination of bile acids from the body in patients with a bile fistula.