Skip to main content
Top
Published in: BMC Gastroenterology 1/2008

Open Access 01-12-2008 | Research article

Bile composition in Alagille Syndrome and PFIC patients having Partial External Biliary Diversion

Authors: Karan M Emerick, Marc S Elias, Hector Melin-Aldana, Sandra Strautnieks, Richard J Thompson, Laura N Bull, AS Knisely, Peter F Whitington, Richard M Green

Published in: BMC Gastroenterology | Issue 1/2008

Login to get access

Abstract

Background

Partial External Biliary Diversion (PEBD) is a surgical intervention to treat children with Progressive Familial Intrahepatic Cholestasis (PFIC) and Alagille syndrome (AGS). PEBD can reduce disease progression, and examining the alterations in biliary lipid composition may be a prognostic factor for outcome.

Methods

Biliary lipid composition and the clinical course of AGS and PFIC patients were examined before and after PEBD.

Results

Pre-PEBD bile from AGS patients had greater chenodeoxycholic/cholic acid (CDCA/CA), bile salt, cholesterol and phospholipid concentrations than PFIC patients. AGS patients, and PFIC patients with familial intrahepatic cholestasis 1 (FIC1) genotype, responded better to PEBD than PFIC patients with bile salt export protein (BSEP) genotype. After successful PEBD, AGS patients have higher biliary lipid concentrations than PFIC patients and PEBD also increases biliary phospholipid concentrations in FIC1 patients.

Conclusion

Both AGS and FIC1 patients can benefit from PEBD, and preserved biliary phospholipid concentrations may be associated with better outcomes post-PEBD.
Appendix
Available only for authorised users
Literature
1.
go back to reference McDaniell R, Warthen DM, Sanchez-Lara PA, Pai A, Krantz ID, Piccoli DA, Spinner NB: Notch2 mutations cause alagille syndrome, a heterogeneous disorder of the notch signaling pathway. Am J Hum Genet. 2006, 79: 169-173. 10.1086/505332.CrossRefPubMedPubMedCentral McDaniell R, Warthen DM, Sanchez-Lara PA, Pai A, Krantz ID, Piccoli DA, Spinner NB: Notch2 mutations cause alagille syndrome, a heterogeneous disorder of the notch signaling pathway. Am J Hum Genet. 2006, 79: 169-173. 10.1086/505332.CrossRefPubMedPubMedCentral
2.
go back to reference Oda T, Elkahloun AG, Pike BL, Okajima K, Krantz ID, Genin A, Piccoli DA, Meltzer PS, Spinner NB, Collins FS, Chandrasekharappa SC: Mutations in the human jagged1 gene are responsible for alagille syndrome. Nat Genet. 1997, 16: 235-242. 10.1038/ng0797-235.CrossRefPubMed Oda T, Elkahloun AG, Pike BL, Okajima K, Krantz ID, Genin A, Piccoli DA, Meltzer PS, Spinner NB, Collins FS, Chandrasekharappa SC: Mutations in the human jagged1 gene are responsible for alagille syndrome. Nat Genet. 1997, 16: 235-242. 10.1038/ng0797-235.CrossRefPubMed
3.
go back to reference Carlton VE, Pawlikowska L, Bull LN: Molecular basis of intrahepatic cholestasis. Ann Med. 2004, 36: 606-617.CrossRefPubMed Carlton VE, Pawlikowska L, Bull LN: Molecular basis of intrahepatic cholestasis. Ann Med. 2004, 36: 606-617.CrossRefPubMed
4.
go back to reference Whitington PF, Freese DK, Alonso EM, Schwarzenberg SJ, Sharp HL: Clinical and biochemical findings in progressive familial intrahepatic cholestasis. J Pediatr Gastroenterol Nutr. 1994, 18: 134-141.CrossRefPubMed Whitington PF, Freese DK, Alonso EM, Schwarzenberg SJ, Sharp HL: Clinical and biochemical findings in progressive familial intrahepatic cholestasis. J Pediatr Gastroenterol Nutr. 1994, 18: 134-141.CrossRefPubMed
5.
go back to reference Bull LN, van Eijk MJ, Pawlikowska L, DeYoung JA, Juijn JA, Liao M, Klomp LW, Lomri N, Berger R, Scharschmidt BF, Knisely AS, Houwen RH, Freimer NB: A gene encoding a p-type atpase mutated in two forms of hereditary cholestasis. Nat Genet. 1998, 18: 219-224. 10.1038/ng0398-219.CrossRefPubMed Bull LN, van Eijk MJ, Pawlikowska L, DeYoung JA, Juijn JA, Liao M, Klomp LW, Lomri N, Berger R, Scharschmidt BF, Knisely AS, Houwen RH, Freimer NB: A gene encoding a p-type atpase mutated in two forms of hereditary cholestasis. Nat Genet. 1998, 18: 219-224. 10.1038/ng0398-219.CrossRefPubMed
6.
go back to reference Strautnieks SS, Bull LN, Knisely AS, Kocoshis SA, Dahl N, Arnell H, Sokal E, Dahan K, Childs S, Ling V, Tanner MS, Kagalwalla AF, Nemeth A, Pawlowska J, Baker A, Mieli-Vergani G, Freimer NB, Gardiner RM, Thompson RJ: A gene encoding a liver-specific abc transporter is mutated in progressive familial intrahepatic cholestasis. Nat Genet. 1998, 20: 233-238. 10.1038/3034.CrossRefPubMed Strautnieks SS, Bull LN, Knisely AS, Kocoshis SA, Dahl N, Arnell H, Sokal E, Dahan K, Childs S, Ling V, Tanner MS, Kagalwalla AF, Nemeth A, Pawlowska J, Baker A, Mieli-Vergani G, Freimer NB, Gardiner RM, Thompson RJ: A gene encoding a liver-specific abc transporter is mutated in progressive familial intrahepatic cholestasis. Nat Genet. 1998, 20: 233-238. 10.1038/3034.CrossRefPubMed
7.
go back to reference Kurbegov AC, Setchell KD, Haas JE, Mierau GW, Narkewicz M, Bancroft JD, Karrer F, Sokol RJ: Biliary diversion for progressive familial intrahepatic cholestasis: Improved liver morphology and bile acid profile. Gastroenterology. 2003, 125: 1227-1234. 10.1016/S0016-5085(03)01199-5.CrossRefPubMed Kurbegov AC, Setchell KD, Haas JE, Mierau GW, Narkewicz M, Bancroft JD, Karrer F, Sokol RJ: Biliary diversion for progressive familial intrahepatic cholestasis: Improved liver morphology and bile acid profile. Gastroenterology. 2003, 125: 1227-1234. 10.1016/S0016-5085(03)01199-5.CrossRefPubMed
8.
go back to reference Whitington PF, Whitington GL: Partial external diversion of bile for the treatment of intractable pruritus associated with intrahepatic cholestasis. Gastroenterology. 1988, 95: 130-136.CrossRefPubMed Whitington PF, Whitington GL: Partial external diversion of bile for the treatment of intractable pruritus associated with intrahepatic cholestasis. Gastroenterology. 1988, 95: 130-136.CrossRefPubMed
9.
go back to reference Emerick KM, Whitington PF: Partial external biliary diversion for intractable pruritus and xanthomas in alagille syndrome. Hepatology. 2002, 35: 1501-1506. 10.1053/jhep.2002.33332.CrossRefPubMed Emerick KM, Whitington PF: Partial external biliary diversion for intractable pruritus and xanthomas in alagille syndrome. Hepatology. 2002, 35: 1501-1506. 10.1053/jhep.2002.33332.CrossRefPubMed
10.
go back to reference Emond JC, Whitington PF: Selective surgical management of progressive familial intrahepatic cholestasis (byler's disease). J Pediatr Surg. 1995, 30: 1635-1641. 10.1016/0022-3468(95)90440-9.CrossRefPubMed Emond JC, Whitington PF: Selective surgical management of progressive familial intrahepatic cholestasis (byler's disease). J Pediatr Surg. 1995, 30: 1635-1641. 10.1016/0022-3468(95)90440-9.CrossRefPubMed
11.
go back to reference Melter M, Rodeck B, Kardorff R, Hoyer PF, Petersen C, Ballauff A, Brodehl J: Progressive familial intrahepatic cholestasis: Partial biliary diversion normalizes serum lipids and improves growth in noncirrhotic patients. Am J Gastroenterol. 2000, 95: 3522-3528. 10.1111/j.1572-0241.2000.03370.x.CrossRefPubMed Melter M, Rodeck B, Kardorff R, Hoyer PF, Petersen C, Ballauff A, Brodehl J: Progressive familial intrahepatic cholestasis: Partial biliary diversion normalizes serum lipids and improves growth in noncirrhotic patients. Am J Gastroenterol. 2000, 95: 3522-3528. 10.1111/j.1572-0241.2000.03370.x.CrossRefPubMed
12.
go back to reference Wanty C, Joomye R, Van Hoorebeek N, Paul K, Otte JB, Reding R, Sokal EM: Fifteen years single center experience in the management of progressive familial intrahepatic cholestasis of infancy. Acta Gastroenterol Belg. 2004, 67: 313-319.PubMed Wanty C, Joomye R, Van Hoorebeek N, Paul K, Otte JB, Reding R, Sokal EM: Fifteen years single center experience in the management of progressive familial intrahepatic cholestasis of infancy. Acta Gastroenterol Belg. 2004, 67: 313-319.PubMed
13.
go back to reference Kalicinski PJ, Ismail H, Jankowska I, Kaminski A, Pawlowska J, Drewniak T, Markiewicz M, Szymczak M: Surgical treatment of progressive familial intrahepatic cholestasis: Comparison of partial external biliary diversion and ileal bypass. Eur J Pediatr Surg. 2003, 13: 307-311. 10.1055/s-2003-43570.CrossRefPubMed Kalicinski PJ, Ismail H, Jankowska I, Kaminski A, Pawlowska J, Drewniak T, Markiewicz M, Szymczak M: Surgical treatment of progressive familial intrahepatic cholestasis: Comparison of partial external biliary diversion and ileal bypass. Eur J Pediatr Surg. 2003, 13: 307-311. 10.1055/s-2003-43570.CrossRefPubMed
14.
go back to reference Pawlikowska L, Groen A, Eppens EF, Kunne C, Ottenhoff R, Looije N, Knisely AS, Killeen NP, Bull LN, Elferink RP, Freimer NB: A mouse genetic model for familial cholestasis caused by atp8b1 mutations reveals perturbed bile salt homeostasis but no impairment in bile secretion. Hum Mol Genet. 2004, 13: 881-892. 10.1093/hmg/ddh100.CrossRefPubMed Pawlikowska L, Groen A, Eppens EF, Kunne C, Ottenhoff R, Looije N, Knisely AS, Killeen NP, Bull LN, Elferink RP, Freimer NB: A mouse genetic model for familial cholestasis caused by atp8b1 mutations reveals perturbed bile salt homeostasis but no impairment in bile secretion. Hum Mol Genet. 2004, 13: 881-892. 10.1093/hmg/ddh100.CrossRefPubMed
15.
go back to reference Smit JJ, Schinkel AH, Oude Elferink RP, Groen AK, Wagenaar E, van Deemter L, Mol CA, Ottenhoff R, Lugt van der NM, van Roon MA, et al: Homozygous disruption of the murine mdr2 p-glycoprotein gene leads to a complete absence of phospholipid from bile and to liver disease. Cell. 1993, 75: 451-462. 10.1016/0092-8674(93)90380-9.CrossRefPubMed Smit JJ, Schinkel AH, Oude Elferink RP, Groen AK, Wagenaar E, van Deemter L, Mol CA, Ottenhoff R, Lugt van der NM, van Roon MA, et al: Homozygous disruption of the murine mdr2 p-glycoprotein gene leads to a complete absence of phospholipid from bile and to liver disease. Cell. 1993, 75: 451-462. 10.1016/0092-8674(93)90380-9.CrossRefPubMed
16.
go back to reference Krantz ID, Piccoli DA, Spinner NB: Clinical and molecular genetics of alagille syndrome. Curr Opin Pediatr. 1999, 11: 558-564. 10.1097/00008480-199912000-00015.CrossRefPubMed Krantz ID, Piccoli DA, Spinner NB: Clinical and molecular genetics of alagille syndrome. Curr Opin Pediatr. 1999, 11: 558-564. 10.1097/00008480-199912000-00015.CrossRefPubMed
17.
go back to reference Alonso EM, Snover DC, Montag A, Freese DK, Whitington PF: Histologic pathology of the liver in progressive familial intrahepatic cholestasis. J Pediatr Gastroenterol Nutr. 1994, 18: 128-133.CrossRefPubMed Alonso EM, Snover DC, Montag A, Freese DK, Whitington PF: Histologic pathology of the liver in progressive familial intrahepatic cholestasis. J Pediatr Gastroenterol Nutr. 1994, 18: 128-133.CrossRefPubMed
18.
go back to reference Klomp LW, Vargas JC, van Mil SW, Pawlikowska L, Strautnieks SS, van Eijk MJ, Juijn JA, Pabon-Pena C, Smith LB, DeYoung JA, Byrne JA, Gombert J, Brugge van der G, Berger R, Jankowska I, Pawlowska J, Villa E, Knisely AS, Thompson RJ, Freimer NB, Houwen RH, Bull LN: Characterization of mutations in atp8b1 associated with hereditary cholestasis. Hepatology. 2004, 40: 27-38. 10.1002/hep.20285.CrossRefPubMed Klomp LW, Vargas JC, van Mil SW, Pawlikowska L, Strautnieks SS, van Eijk MJ, Juijn JA, Pabon-Pena C, Smith LB, DeYoung JA, Byrne JA, Gombert J, Brugge van der G, Berger R, Jankowska I, Pawlowska J, Villa E, Knisely AS, Thompson RJ, Freimer NB, Houwen RH, Bull LN: Characterization of mutations in atp8b1 associated with hereditary cholestasis. Hepatology. 2004, 40: 27-38. 10.1002/hep.20285.CrossRefPubMed
19.
go back to reference Knisely AS, Strautnieks SS, Meier Y, Stieger B, Byrne JA, Portmann BC, Bull LN, Pawlikowska L, Bilezikci B, Ozcay F, Laszlo A, Tiszlavicz L, Moore L, Raftos J, Arnell H, Fischler B, Nemeth A, Papadogiannakis N, Cielecka-Kuszyk J, Jankowska I, Pawlowska J, Melin-Aldana H, Emerick KM, Whitington PF, Mieli-Vergani G, Thompson RJ: Hepatocellular carcinoma in ten children under five years of age with bile salt export pump deficiency. Hepatology. 2006, 44: 478-486. 10.1002/hep.21287.CrossRefPubMed Knisely AS, Strautnieks SS, Meier Y, Stieger B, Byrne JA, Portmann BC, Bull LN, Pawlikowska L, Bilezikci B, Ozcay F, Laszlo A, Tiszlavicz L, Moore L, Raftos J, Arnell H, Fischler B, Nemeth A, Papadogiannakis N, Cielecka-Kuszyk J, Jankowska I, Pawlowska J, Melin-Aldana H, Emerick KM, Whitington PF, Mieli-Vergani G, Thompson RJ: Hepatocellular carcinoma in ten children under five years of age with bile salt export pump deficiency. Hepatology. 2006, 44: 478-486. 10.1002/hep.21287.CrossRefPubMed
20.
go back to reference Wang DQ, Paigen B, Carey MC: Phenotypic characterization of lith genes that determine susceptibility to cholesterol cholelithiasis in inbred mice: Physical-chemistry of gallbladder bile. J Lipid Res. 1997, 38: 1395-1411.PubMed Wang DQ, Paigen B, Carey MC: Phenotypic characterization of lith genes that determine susceptibility to cholesterol cholelithiasis in inbred mice: Physical-chemistry of gallbladder bile. J Lipid Res. 1997, 38: 1395-1411.PubMed
21.
go back to reference Heuman DM: Quantitative estimation of the hydrophilic-hydrophobic balance of mixed bile salt solutions. J Lipid Res. 1989, 30: 719-730.PubMed Heuman DM: Quantitative estimation of the hydrophilic-hydrophobic balance of mixed bile salt solutions. J Lipid Res. 1989, 30: 719-730.PubMed
22.
go back to reference Bartlett G: Phosphorus assay in column chromatography. J Lipid Res. 1959, 30: 719-730. Bartlett G: Phosphorus assay in column chromatography. J Lipid Res. 1959, 30: 719-730.
23.
go back to reference Emerick KM, Whitington PF: Clinical aspects of familial cholestasis (with molecular explanations). Curr Gastroenterol Rep. 1999, 1: 223-230. 10.1007/s11894-999-0039-x.CrossRefPubMed Emerick KM, Whitington PF: Clinical aspects of familial cholestasis (with molecular explanations). Curr Gastroenterol Rep. 1999, 1: 223-230. 10.1007/s11894-999-0039-x.CrossRefPubMed
24.
go back to reference Alagille D, Estrada A, Hadchouel M, Gautier M, Odievre M, Dommergues JP: Syndromic paucity of interlobular bile ducts (alagille syndrome or arteriohepatic dysplasia): Review of 80 cases. J Pediatr. 1987, 110: 195-200. 10.1016/S0022-3476(87)80153-1.CrossRefPubMed Alagille D, Estrada A, Hadchouel M, Gautier M, Odievre M, Dommergues JP: Syndromic paucity of interlobular bile ducts (alagille syndrome or arteriohepatic dysplasia): Review of 80 cases. J Pediatr. 1987, 110: 195-200. 10.1016/S0022-3476(87)80153-1.CrossRefPubMed
25.
go back to reference Libbrecht L, Spinner NB, Moore EC, Cassiman D, Van Damme-Lombaerts R, Roskams T: Peripheral bile duct paucity and cholestasis in the liver of a patient with alagille syndrome: Further evidence supporting a lack of postnatal bile duct branching and elongation. Am J Surg Pathol. 2005, 29: 820-826. 10.1097/01.pas.0000161325.36348.25.CrossRefPubMed Libbrecht L, Spinner NB, Moore EC, Cassiman D, Van Damme-Lombaerts R, Roskams T: Peripheral bile duct paucity and cholestasis in the liver of a patient with alagille syndrome: Further evidence supporting a lack of postnatal bile duct branching and elongation. Am J Surg Pathol. 2005, 29: 820-826. 10.1097/01.pas.0000161325.36348.25.CrossRefPubMed
26.
go back to reference Williams GJ, Whitington PF, Weidman SW, Black DD, Sabesin SM: Correctable plasma lipoprotein abnormalities in infants with choledochal cysts. Pediatr Res. 1985, 19: 240-247. 10.1203/00006450-198502000-00021.CrossRefPubMed Williams GJ, Whitington PF, Weidman SW, Black DD, Sabesin SM: Correctable plasma lipoprotein abnormalities in infants with choledochal cysts. Pediatr Res. 1985, 19: 240-247. 10.1203/00006450-198502000-00021.CrossRefPubMed
27.
go back to reference Davit-Spraul A, Pourci ML, Atger V, Cambillau M, Hadchouel M, Moatti N, Legrand A: Abnormal lipoprotein pattern in patients with alagille syndrome depends on icterus severity. Gastroenterology. 1996, 111: 1023-1032. 10.1016/S0016-5085(96)70071-9.CrossRefPubMed Davit-Spraul A, Pourci ML, Atger V, Cambillau M, Hadchouel M, Moatti N, Legrand A: Abnormal lipoprotein pattern in patients with alagille syndrome depends on icterus severity. Gastroenterology. 1996, 111: 1023-1032. 10.1016/S0016-5085(96)70071-9.CrossRefPubMed
28.
go back to reference Gottrand F, Clavey V, Fruchart JC, Farriaux JP: Lipoprotein pattern and plasma lecithin cholesterol acyl transferase activity in children with alagille syndrome. Atherosclerosis. 1995, 115: 233-241. 10.1016/0021-9150(94)05521-J.CrossRefPubMed Gottrand F, Clavey V, Fruchart JC, Farriaux JP: Lipoprotein pattern and plasma lecithin cholesterol acyl transferase activity in children with alagille syndrome. Atherosclerosis. 1995, 115: 233-241. 10.1016/0021-9150(94)05521-J.CrossRefPubMed
29.
go back to reference Heubi JE, Soloway RD, Balistreri WF: Biliary lipid composition in healthy and diseased infants, children, and young adults. Gastroenterology. 1982, 82: 1295-1299.PubMed Heubi JE, Soloway RD, Balistreri WF: Biliary lipid composition in healthy and diseased infants, children, and young adults. Gastroenterology. 1982, 82: 1295-1299.PubMed
30.
go back to reference Lykavieris P, Hadchouel M, Chardot C, Bernard O: Outcome of liver disease in children with alagille syndrome: A study of 163 patients. Gut. 2001, 49: 431-435. 10.1136/gut.49.3.431.CrossRefPubMedPubMedCentral Lykavieris P, Hadchouel M, Chardot C, Bernard O: Outcome of liver disease in children with alagille syndrome: A study of 163 patients. Gut. 2001, 49: 431-435. 10.1136/gut.49.3.431.CrossRefPubMedPubMedCentral
31.
go back to reference Bojanovski M, Lukermann R, Schulz-Falten J, Sturm E, Burdelski M, Bojanovski D: Parameters of lipoprotein metabolism and cholestasis in healthy and cholestatic infants and children. Prog Lipid Res. 1991, 30: 295-300. 10.1016/0163-7827(91)90027-3.CrossRefPubMed Bojanovski M, Lukermann R, Schulz-Falten J, Sturm E, Burdelski M, Bojanovski D: Parameters of lipoprotein metabolism and cholestasis in healthy and cholestatic infants and children. Prog Lipid Res. 1991, 30: 295-300. 10.1016/0163-7827(91)90027-3.CrossRefPubMed
32.
go back to reference Nagasaka H, Yorifuji T, Egawa H, Yanai H, Fujisawa T, Kosugiyama K, Matsui A, Hasegawa M, Okada T, Takayanagi M, Chiba H, Kobayashi K: Evaluation of risk for atherosclerosis in alagille syndrome and progressive familial intrahepatic cholestasis: Two congenital cholestatic diseases with different lipoprotein metabolisms. J Pediatr. 2005, 146: 329-335. 10.1016/j.jpeds.2004.10.047.CrossRefPubMed Nagasaka H, Yorifuji T, Egawa H, Yanai H, Fujisawa T, Kosugiyama K, Matsui A, Hasegawa M, Okada T, Takayanagi M, Chiba H, Kobayashi K: Evaluation of risk for atherosclerosis in alagille syndrome and progressive familial intrahepatic cholestasis: Two congenital cholestatic diseases with different lipoprotein metabolisms. J Pediatr. 2005, 146: 329-335. 10.1016/j.jpeds.2004.10.047.CrossRefPubMed
33.
go back to reference Tazawa Y, Yamada M, Nakagawa M, Konno T, Tada K: Bile acid profiles in siblings with progressive intrahepatic cholestasis: Absence of biliary chenodeoxycholate. J Pediatr Gastroenterol Nutr. 1985, 4: 32-37.CrossRefPubMed Tazawa Y, Yamada M, Nakagawa M, Konno T, Tada K: Bile acid profiles in siblings with progressive intrahepatic cholestasis: Absence of biliary chenodeoxycholate. J Pediatr Gastroenterol Nutr. 1985, 4: 32-37.CrossRefPubMed
34.
go back to reference Jacquemin E, Dumont M, Bernard O, Erlinger S, Hadchouel M: Evidence for defective primary bile acid secretion in children with progressive familial intrahepatic cholestasis (byler disease). Eur J Pediatr. 1994, 153: 424-428. 10.1007/BF01983406.CrossRefPubMed Jacquemin E, Dumont M, Bernard O, Erlinger S, Hadchouel M: Evidence for defective primary bile acid secretion in children with progressive familial intrahepatic cholestasis (byler disease). Eur J Pediatr. 1994, 153: 424-428. 10.1007/BF01983406.CrossRefPubMed
35.
go back to reference Bull LN, Carlton VE, Stricker NL, Baharloo S, DeYoung JA, Freimer NB, Magid MS, Kahn E, Markowitz J, DiCarlo FJ, McLoughlin L, Boyle JT, Dahms BB, Faught PR, Fitzgerald JF, Piccoli DA, Witzleben CL, O'Connell NC, Setchell KD, Agostini RM, Kocoshis SA, Reyes J, Knisely AS: Genetic and morphological findings in progressive familial intrahepatic cholestasis (byler disease [pfic-1] and byler syndrome): Evidence for heterogeneity. Hepatology. 1997, 26: 155-164. 10.1002/hep.510260121.CrossRefPubMed Bull LN, Carlton VE, Stricker NL, Baharloo S, DeYoung JA, Freimer NB, Magid MS, Kahn E, Markowitz J, DiCarlo FJ, McLoughlin L, Boyle JT, Dahms BB, Faught PR, Fitzgerald JF, Piccoli DA, Witzleben CL, O'Connell NC, Setchell KD, Agostini RM, Kocoshis SA, Reyes J, Knisely AS: Genetic and morphological findings in progressive familial intrahepatic cholestasis (byler disease [pfic-1] and byler syndrome): Evidence for heterogeneity. Hepatology. 1997, 26: 155-164. 10.1002/hep.510260121.CrossRefPubMed
36.
go back to reference Redinger RN, Passi RB: Effects of plasma cholesterol lowering agents on hepatobiliary lipid metabolism and cholesterol turnover in the rhesus monkey. Can J Physiol Pharmacol. 1979, 57: 235-241.CrossRefPubMed Redinger RN, Passi RB: Effects of plasma cholesterol lowering agents on hepatobiliary lipid metabolism and cholesterol turnover in the rhesus monkey. Can J Physiol Pharmacol. 1979, 57: 235-241.CrossRefPubMed
37.
go back to reference Stapelbroek JM, van Erpecum KJ, Klomp LW, Venneman NG, Schwartz TP, van Berge Henegouwen GP, Devlin J, van Nieuwkerk CM, Knisely AS, Houwen RH: Nasobiliary drainage induces long-lasting remission in benign recurrent intrahepatic cholestasis. Hepatology. 2006, 43: 51-53. 10.1002/hep.20998.CrossRefPubMed Stapelbroek JM, van Erpecum KJ, Klomp LW, Venneman NG, Schwartz TP, van Berge Henegouwen GP, Devlin J, van Nieuwkerk CM, Knisely AS, Houwen RH: Nasobiliary drainage induces long-lasting remission in benign recurrent intrahepatic cholestasis. Hepatology. 2006, 43: 51-53. 10.1002/hep.20998.CrossRefPubMed
Metadata
Title
Bile composition in Alagille Syndrome and PFIC patients having Partial External Biliary Diversion
Authors
Karan M Emerick
Marc S Elias
Hector Melin-Aldana
Sandra Strautnieks
Richard J Thompson
Laura N Bull
AS Knisely
Peter F Whitington
Richard M Green
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2008
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/1471-230X-8-47

Other articles of this Issue 1/2008

BMC Gastroenterology 1/2008 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine