Gastroenterologia Japonica

, Volume 22, Issue 5, pp 614–620 | Cite as

Serum bile acids and oral ursodeoxycholic acid tolerance test in the diagnosis of esophageal varices

  • Mishio Kadohara
  • Hironaka Kawasaki
  • Chisato Hirayama
Original Article


The purpose of this study was to compare the endoscopic findings based on the general rules for recording endoscopic findings on esophageal varices by the Japanese Research Society for Portal Hypertension with liver function tests including serum bile acids and bile acid clearance tests in 64 patients with liver cirrhosis. Cases of esophageal varices showed significantly higher serum bile acid levels and greater ICG retention than those without esophageal varices. The oral ursodeoxycholic acid tolerance test was significantly impaired in the group with esophageal varices (p<0.05). In cases with esophageal varices, there was no significant difference in serum bile acid levels between white and blue varix patients, while serum bile acid levels in the red-color sign-positive group were significantly higher than those in the negative group (p<0.01). Serum bile acid levels increased in parallel with the form of varices as reflected by the shape and size of varices and with the location of varices which reflects the longitudinal extent of varices. These results indicate that the impaired clearance of serum bile acids in liver cirrhosis is closely related with the red-color sign on the variceal surface and with the form and location of esophageal varices, which may reflect the grade of portal-systemic shunting.

Key words

Esophageal varices Liver cirrhosis Serum bile acid Ursodeoxycholic acid 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1).
    Japanese Research Society for Portal Hypertension (Chairman: K Inokuchi): The general rules for recording endoscopic findings on esophageal varices. Jpn J Surg 1980; 10: 84–87CrossRefGoogle Scholar
  2. 2).
    Beppu K, Inokuchi K, Koyanagi N, et al: Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc 1981; 27: 213–218PubMedCrossRefGoogle Scholar
  3. 3).
    Conn HO: Ammonia tolerance in the diagnosis of esophageal varices. A comparison of endoscopic, radiologic, and biochemical techniques. J Lab Clin Med 1967; 70: 442–451PubMedGoogle Scholar
  4. 4).
    Kadohara M, Kawasaki H: A study of correlationship between endoscopie findings of esophageal varices and biochemical liver function tests and liver scintigram (abstr). Jpn J Gastroenterol 1982; 79: 1358 (Jpn)Google Scholar
  5. 5).
    Gilmore IT, Thompson RPH: Plasma clearance of oral and intravenous cholic acid in subjects with and without chronic liver disease. Gut 1980; 21: 123–127PubMedCrossRefGoogle Scholar
  6. 6).
    Paré P, Hoefs JC, Ashcavai M: Determinants of serum bile acids in chronic liver disease. Gastroenterology 1981; 81: 959–964PubMedGoogle Scholar
  7. 7).
    Miescher G, Paumgartner G, Preisig R: Portal-systemic spill-over of bile acids: A study of mechanisms using ursodeoxycholic acid. Eur J Clin Invest 1983; 13: 439–445PubMedGoogle Scholar
  8. 8).
    Ohkubo H, Okuda K, Iida S, et al: Role of portal and splenic vein shunts and impaired hepatic extraction in the elevated serum bile acids in liver cirrhosis. Gastroenterology 1984; 86: 514–520PubMedGoogle Scholar
  9. 9).
    Hirayama C, Irisa T, Arimura K, et al: Diagnostic significance of fasting serum bile acid in liver disease. Acta Hepato-Gastroenterol 1976; 23: 385–391Google Scholar
  10. 10).
    Osuga T, Mitamura K, Mashige F, et al: Evaluation of fluorimetrically estimated serum bile acid in liver disease. Clin Chim Acta 1977; 75: 81–90PubMedCrossRefGoogle Scholar
  11. 11).
    Yamanishi Y, Kishimoto Y, Kawasaki H, et al: Oral ursodeoxycholic acid tolerance test in liver disease. Gastroenterol Jpn 1981; 16: 472–477PubMedGoogle Scholar
  12. 12).
    Kawasaki H, Yamanishi Y, Kishimoto Y, et al: Abnormality of oral ursodeoxycholic acid tolerance test in the Dubin-Johnson syndrome. Clin Chim Acta 1981; 112: 13–19PubMedCrossRefGoogle Scholar
  13. 13).
    Kawasaki H, Kimura N, Irisa T, et al: Dye clearance studies in Rotor’s syndrome. Am J Gastroenterol 1979; 71: 380–388PubMedGoogle Scholar
  14. 14).
    Mannes GA, Thieme C, Stellaard F, et al: Prognostic significance of serum bile acids in cirrhosis. Hepatology 1986; 6: 50–53PubMedCrossRefGoogle Scholar
  15. 15).
    Fedorowski T, Salen G, Colallilo A, et al: Metabolism of ursodeoxycholic acid in man. Gastroenterology 1977; 73:1131–1137PubMedGoogle Scholar
  16. 16).
    Paumgartner G, Mannes GA, Stellaard F: Serum bile acids and bile acid tolerance tests in liver disease. In: Barbara L, Dowling RH, Hofmann AF, Roda E, eds. Bile acids in gastroenterology. MTP Press Ltd., Lancaster. 1983; 217–222Google Scholar
  17. 17).
    Islam S, Poupon RE, Barbara JC, et al: Fasting serum bile acid level in cirrhosis. A semi-quantitative index of hepatic function. J Hepatology 1985; 1: 609–617CrossRefGoogle Scholar
  18. 18).
    Iida S, Ohnishi K, Tanaka H, et al: The study of factors affecting the elevation of fasting serum total bile acid concentrations in liver cirrhosis. -A comparative study with idiopathic portal hypertension-. Acta Hepat Jap 1987; 28: 208–213 (Jpn)Google Scholar
  19. 19).
    Marigold JH, Bull HJ, Gilmore IT, et al: Direct measurement of hepatic extraction of chenodeoxycholic acid and ursodeoxycholic acid in man. Clin Sci 1982; 63: 197–203PubMedGoogle Scholar

Copyright information

© The Japanese Society of Gastroenterobgy 1987

Authors and Affiliations

  • Mishio Kadohara
    • 1
  • Hironaka Kawasaki
    • 1
  • Chisato Hirayama
    • 1
  1. 1.Second Department of Internal MedicineTottori University School of MedicineYonagoJapan

Personalised recommendations