Clinical relevance

Approximately 95% of BA are recycled by the body in the enterohepatic circulation. Under normal conditions, the liver removes BA from the hepatic-portal circulation, so that peripheral blood levels of TBA are ≤ 10 μmol/L. In case of liver malfunction one or more steps of the enterohepatic circulation can be compromised, which results in abnormal serum TBA values. Therefore, serum TBA levels are a sensitive marker for liver function reflecting hepatic synthesis, secretion and re-absorption. Increased serum TBA levels are associated with several diseases such as acute and chronic hepatitis, intrahepatic cholestasis of pregnancy (ICP), liver sclerosis, cirrhosis, and cancer. Decreased serum TBA levels are associated with ileal dysfunction, malabsorption, diarrhea or Crohn’s disease. Although TBA levels provide an early diagnosis of hepatobiliary deficiencies, they do not allow the differentiation between various diseases. Additionally, serum TBA is used to monitor treatment response of patients suffering from liver disease. [1-12]