Study of intrahepatic cholestasis of pregnancy before and after treatment with ursodeoxycholic acid

To investigate bile acids patterns in patients with intrahepatic cholestasis of pregnancy [ICP] and to test the efficacy of ursodeoxycholic acid [UDCA] treatment. The study included a reference group comprised ten healthy pregnant women and 21 patients with ICP, who were randomly divided into 2 groups, one received UDCA for 21 days and followed until delivery [11 cases] and the other received vitamin B as a placebo and followed in time same manner [10 cases]. Bile acids were analyzed by gas chromatography-mass spectrometry in maternal serum at the start, 21 days later and after delivery. They were also analyzed in amniotic fluid and neonatal meconium after delivery. UDCA treatment improved bile acid levels after 21 days and markedly after delivery. Amniotic fluid levels of bile acids were lower in UDGA treated cases than placebo treated cases. Neonatal meconium bile acids were higher in placebo treated ICP cases than reference cases. After delivery, serum TBA and cholic acid in UDC'A treated cases were correlated with those in amniotic fluid [r = 0.91, r = 0.6], with positive correlations with neonatal meconium TBA [r= 0.39]. The obstetric and neonatal outcomes were better in UDCA treated cases tf compared to placebo cases. Ursodeoxycholic acid is effective and safe in patients with intrahepatic cholestasis of pregnancy. It attenuates pruritus, corrects bile acid abnormalities in the mothers and improves fetal and neonatal outcomes

Changes in bile acid metabolism in thyroid dysfunction

Bile acid kinetics in thyroid dysfunction attracted the attention of many investigators but the reports were confilicting. To analyze the mechanisms behind this controversy serum conjugated bile acid profile was examined, 18 hyperthyroid, 21 treated thyroid patients and 34 healthy controls were studied. The treated patients were euthyroid. Bile acid concentration was estimated by reverse phase liquid chromatography. Total bile acid was not significantly different in all groups. A marked shift of bile acid DCA to CDCA was observed with increased thyroid activity. The serum bile acid profile of medically treated patients was similar to that of control group. The ratio of cholic acid and its secondary bile acid deoxycholic acid/chenodeoxycholic acid and its secondary bile acid lithocholic acid is a good indicator of the shift in bile acid synthesis as it accounts for changes in bowel conditions. Thyroid hormone seems to have a specific action on the enzyme responsible for bile synthesis rather than changing total bile acid production