Validity and Sensitivity of an Intravenous Bile Acid Tolerance Test in Patients with Liver Disease

A bile acid tolerance test, which measures the plasma disappearance rate of injected cholyglycine by radioimmunoassay, was studied in 36 patients with biopsy-proved chronic liver disease and compared to fasting-state levels of conjugated cholic acid and other conventional liver tests. In 25 patients in whom one or more of the conventional tests for liver disease showed abnormal results, fasting-state levels of conjugated cholic acid were increased in 20, but plasma disappearance of cholylglycine was delayed in all. Of the 11 other patients in whom conventional tests were within normal limits, fasting-state levels of conjugated cholic acid were increased in three of 10, but cholylglycine disappearance was delayed in nine of 11. The bile acid tolerance test indicated liver disease more sensitively than the fasting-state level of conjugated cholic acid, which, in turn, was more sensitive than other conventional liver tests. (N Engl J Med 292:1209–1214, 1975), UPTAKE and biliary secretion of bile acids are major hepatic functions,.