Decreased bile acid synthesis with total parenteral nutrition

Abstract 

Background

Biliary changes occur in patients on total parenteral nutrition (TPN) predisposing them to gallstones and cholestasis. We hypothesized that patients on TPN, similar to animal models, would have reduced bile acid synthesis.

Methods

Serum from 13 controls and 17 patients on TPN were collected and tested with HPLC for 7α-hydroxy-4-cholesten-3-one, which has been shown to correlate with bile acid synthesis. Somatostatin and tumor necrosis factor α levels were determined with enzyme-linked immunosorbent assays.

Results

Bile acid synthesis was significantly reduced in patients on TPN. TPN patients on oral feeding (but not jejunostomy) had similar bile acid synthesis rates as controls. In patients on TPN and nothing by mouth, somatostatin had a significant negative correlation with bile acid synthesis (P < .01).

Conclusion

TPN patients have a reduced bile acid synthesis, and this correlates with somatostatin if they are treated with nothing by mouth. Oral feeding is associated with a higher bile acid synthesis, and body mass index, age, albumin, and tumor necrosis factor α do not have an effect on bile acid synthesis.

Keywords: Total parenteral nutrition, Bile acid synthesis, Cholestasis, Somatostatin