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Postprandial bile acid levels in intestine and plasma reveal altered biliary circulation in chronic pancreatitis patients

Abstract : Bile acid (BA) secretion and circulation in chronic pancreatitis (CP) patients with exocrine pancreatic insufficiency (EPI) were investigated by measuring simultaneously postprandial levels of individual BAs in duodenal contents and blood plasma using LC-MS/MS. CP patients and healthy volunteers (HV) were intubated with gastric and duodenal tubes prior to the administration of a test meal and continuous aspiration of duodenal contents. Pancreatic lipase outputs in CP patients were very low (0.7±0.2 mg) vs. HV (116.7±68.1 mg; P<0.005), thus confirming the severity of EPI. Duodenal BA outputs were reduced in CP patients (1.00±0.89 mmoles; 0.47±0.42 g) vs. HV (5.52±4.53 mmoles; 2.62±2.14 g; P<0.15). Primary to secondary BA ratio was considerably higher in CP patients (38.09±48.1) than HV (4.15±2.37; P<0.15), indicating an impaired transformation of BAs by gut microbiota. BA concentrations were found below the critical micellar concentration in CP patients, while a high BA concentration peak corresponding to gallblader emptying was evidenced in HV. Conversely, BA plasma concentration was increased in CP patients vs. HV suggesting a cholangiohepatic shunt of BA secretion. Alterations of BA circulation and levels may result from the main biliary duct stenosis observed in these CP patients. They may aggravate the consequences of EPI on lipid malabsorption.
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Submitted on : Wednesday, January 23, 2019 - 10:39:53 AM
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Humbert et al-J Lipid Res-2018...
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Lydie Humbert, Dominique Rainteau, Noshine Tuvignon, Claude Wolf, Philippe Seksik, et al.. Postprandial bile acid levels in intestine and plasma reveal altered biliary circulation in chronic pancreatitis patients. Journal of Lipid Research, American Society for Biochemistry and Molecular Biology, 2018, 59 (11), pp.2202-2213. ⟨10.1194/jlr.M084830⟩. ⟨hal-01990491⟩



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