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Serum and biliary unsulfated bile acids were studied using a gas chromatographic method in 8 patients before and 2 months after portacaval anastomosis. Total serum bile acids were 21.6 +/- 3.6 mumol/liter before and 68.0 +/- 8.6 mumol/liter after surgery (P less than 0.005). Cholic acid rose from 26.5 +/- 3.4% to 33.8 +/- 4.8% (P less than 0.02) of the total serum bile acids, while chenodeoxycholic acid decreased from 67.9 +/- 4.1% to 60.8 +/- 4.3% (P less than 0.05). The relative concentration of cholic and chenodeoxycholic acids in bile increased slightly but not significantly after surgery, while deoxycholate fell from 8.5 +/- 1.7% to 2.1 +/- 0.6%. CONCLUSIONS (1) in cirrhosis the serum and biliary bile acid composition are markedly different, the cholic-chenodeoxycholic ratio being much lower in serum than in bile; (2) after portacaval anastomosis serum and biliary bile acid patterns tend to become similar; (3) percent biliary deoxycholate decreases significantly after surgery.
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