Plasma clearance of oral and intravenous cholic acid in subjects with and without chronic liver disease

SUMMARY The apparent plasms cleaiances of tracer amounts of radiolabelled cholic acid given orally or intravenously were compared in 14 control subjects and 20 patients with chronic liver disease. The clearance after oral administration was the more sensitive in detecting chronic liver disease and correlated better with the fasting levels of endogenous serum bile acid. This agrees with the predicted effects on clearance of hepatocellular damage and portal-systemic shunting of blood after the two routes of administration. The estimated hepatic extraction ratio, calculated from the ratio of the oral and intravenous clearances, was 0-77 +0.02 (mean ISEM) in control subjects, 0.64±0.03 in patients with anicteric chronic liver disease, and 0.46±0-05 in those with icteric chronic liver disease. The concentration of endogenous bile acids in blood is a useful marker of liver disease1 2 and of com-parable sensitivity to levels of a-glutamyl trans-peptidase or aspartate aminotransferase.34 Para-doxically, the disappearance rate from plasma of intravenously administered radiolabelled bile acids