Therapeutic Agents in Bile Salts

Bile salts have been used for centuries as digestive aids and cathartics. Their use for these purposes has become more limited recently, and this is probably appropriate until better preparations become available and indications for their administration become more clearly defined. Most commercial bile salt preparations are desiccated or crude extracts of cattle bile containing mainly unconjugated bile salts with small amounts of pigment and lipids. They are generally supplied as 0.2- or 0.3-g tablets. The customary dose is 0.4-0.6 g three times daily with meals. This is probably an inadequate dose, as will be explained later. Dehydrocholic acid, 3,7,12-triketo-5j -cholanoic acid, is oxidized cholic acid and is supplied in pure form but does not form micelles and hence probably does not assist fat absorption significantly and would be of little value for replacement therapy. Sodium dehydrocholate is supplied as a 20 % solution in ampules and is widely used to measure blood circulation times. It does not appear to be conjugated by the liver (86). 

The most common situations in which bile salts are deficient in the small intestine are (1) T-tube drainage of the common bile duct and (2) partial or complete interruption of ileal absorption, as in regional enteritis or ileal resection or bypass. In the former group, bile drainage is usually incomplete and temporary, so that most patients tolerate this period well without 

Administration of 3.5 g bile salts with meals is therapeutic in postile-ectomy steatorrhea (89). Bile salts in this condition may aggravate diarrhea, however, and the use of medium-chain triglycerides as a fat source and cholestyramine to bind bile salts has been recommended as a means of dealing with steatorrhea in the presence of cholerheic diarrhea (90,91). 

Administration of bile salts in jaundice caused by hepatobiliary disease is contraindicated, especially if pruritus is present, as bile salts will only aggravate this. 

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