Digestive Diseases and Sciences

, Volume 44, Issue 1, pp 14–19 | Cite as

Bile Acid Malabsorption as a Cause of Chronic Diarrhea Diagnostic Value of 7α-Hydroxy-4-Cholesten-3-One in Serum

  • Gerd H. Sauter
  • Wolfgang Munzing
  • Christoph Von Ritter
  • Gustav Paumgartner


To evaluate the usefulness of7α-hydroxy-4-cholesten-3-one (HCO) serumconcentrations as a diagnostic marker of bile acidmalabsorption, we determined the reference range of HCOin 106 normal subjects (age 40.2 ± 16.8 years; 55 women, 51men) and conducted a utility study in 23 patients withchronic diarrhea of unknown origin (age 49.4 ±15.3 years, 13 women, 10 men). The diagnosis of bileacid malabsorption was made on the basis of a decreased retentionof [75Se]homocholyltaurine after oralapplication (75SeHCAT test). HCO (referencerange: 6-48 ng/ml) and the 75SeHCAT testyielded the same results in 19/23 (83%) patients. Bile acid malabsorption wasidentified by an increase of HCO in serum with asensitivity of 90% and a specificity of 79%. Analysis ofHCO in serum may serve as a novel, simple, and sensitive method for the detection of bile acidmalabsorption in patients with chronic diarrhea ofunknown origin.



Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ford GA, Preece JD, Davies IH, Wilkinson SP: Use of the SeHCAT test in the investigation of diarrhoea. Postgrad Med J 68:272–276, 1992Google Scholar
  2. 2.
    Williams AJK, Merrick MV, Eastwood MA: Idiopathic bile acid malabsorption· a review of clinical presentation, diagnosis, and responseto treatment. Gut 32:1004–1006, 1991Google Scholar
  3. 3.
    Merrick MV, Eastwood MA, Ford MJ: Is bileacid malabsorption underdiagnosed? An evaluation of accuracy of diagnosis by measurements of SeHCAT retention. Br Med J 290:665–668, 1985Google Scholar
  4. 4.
    Hofmann AF: The syndromeof ileal diseaseand thebroken enterohepatic circulation: cholerheic enteropathy. Gastroenterology 52:752–757, 1967Google Scholar
  5. 5.
    Fromm H, Malavolti M: Bileacid-induced diarrhoea. Clin Gastroenterol 15:567–582, 1986Google Scholar
  6. 6.
    Otte JJ, Andersen JR: Theclinical valueof faecal bileacid determination in patients with chronic diarrhoea of unknown origin. Scand J Gastroenterol 21:585–588, 1986Google Scholar
  7. 7.
    Aldini R, Roda A, Festi D, Mazzella G, Morselli AM, Sama C, Roda E, Scopinaro N, Barbara L: Diagnostic valueof serum primary bileacids in detecting bileacid malabsorption. Gut 23:829–834, 1982Google Scholar
  8. 8.
    Fromm H, Hofmann AF: Breath test for altered bileacid metabolism. Lancet 2:621–625, 1971Google Scholar
  9. 9.
    Merrick MV, Eastwood MA, Anderson JR, Ross HM: Enterohepatic circulation in man of a gamma-emitting bile-acid conjugate, 23-selena-25-homotaurocholic acid (SeHCAT). J Nucl Med 23:126–130, 1982Google Scholar
  10. 10.
    Axelson M, Björkhem I, Reihnér E, Einarsson K: Theplasma level of 7a-hydroxy-4-cholesten-3-one reflects theactivity of hepatic cholesterol 7a-hydroxylasein man. FEBS Lett 284:216–218, 1991Google Scholar
  11. 11.
    Axelson M, Aly A, Sjövall J: Level of 7a-hydroxy-4-cholesten-3-onein plasma reflect rates of bileacid synthesis. FEBS Lett 239:324–328, 1988Google Scholar
  12. 12.
    Eusufzai S, Axelson M, Angelin B, Einarsson K: Serum 7a-hydroxy-4-cholesten-3-oneconcentrations in theevaluation of bileacid malabsorption in patients with diarrhoe: correlation to SeHCAT test. Gut 34:698–701, 1993Google Scholar
  13. 13.
    Brydon WG, Nyhlin H, Eastwood MA, Merrick MV: Serum 7a-hydroxy-4-cholesten-3-oneand selenohomocholyltaurine (SeHCAT) wholebody retention in theassessment of bileacid induced diarrhoea. Eur J Gastroenterol Hepatol 8:117–123, 1996Google Scholar
  14. 14.
    PetitClerc C, Solberg HE: International Federation of Clinical Chemistry (IFCC): Approved recommendations (1987) on the theory of referencevalues. Part 2. Selection of individuals for theproduction of referencevalues. J Clin Chem Clin Biochem 25:639–644, 1987Google Scholar
  15. 15.
    Nyhlin H, Merrick MV, Eastwood MA, Brydon WG: Evaluation of ileal function using 23-selena-25-homotaurocholate, a gamma-labeled conjugated bileacid. Gastroenterology 84:63–68, 1983Google Scholar
  16. 16.
    Pettersson L, Eriksson CG: Reversed-phasehigh-performance liquid chromatographic determination of 7a-hydroxy-4-cholesten-3-onein human serum. J Chromatogr B 657:31–36, 1994Google Scholar
  17. 17.
    Lilliefors HW: On theKolmogorov-Smirnov test for normality with mean and varianceunknown. J Am Statist Assoc 62:399–402, 1967Google Scholar
  18. 18.
    Heiss G, Tamir I, Davis CE, Tyroler HA, Rifkind BM, Schon-field G, Jacobs D, Frantz ID Jr: Lipoprotein-cholesterol distributions in selected North American populations: TheLipid Research Clinics Program PrevalenceStudy. Circulation 61:302–315, 1980Google Scholar
  19. 19.
    Abbott RD, Garrison RJ, Wilson WPF, Epstein FH, Castelli WP, Feinleib M, LaRue C: Joint distribution of lipoprotein cholesterol classes. TheFramingham study. Arteriosclerosis 3:260–272, 1983Google Scholar
  20. 20.
    Sauter G, Berr F, Beuers U, Fischer S, Paumgartner G: Serum concentrations of 7a-hydroxy-4-cholesten-3-one reflect bile acid synthesis in man. Hepatology 24:123–126, 1996Google Scholar
  21. 21.
    Bertolotti M, Abate N, Bertolotti S, Loria P, Concari M, Messora R, Carubbi F, Pinetti A, Carulli N: Effect of aging on cholesterol 7a-hydroxylation in humans. J Lipid Res 34:1001–1007, 1993Google Scholar

Copyright information

© Plenum Publishing Corporation 1999

Authors and Affiliations

  • Gerd H. Sauter
  • Wolfgang Munzing
  • Christoph Von Ritter
  • Gustav Paumgartner

There are no affiliations available

Personalised recommendations