Choleresis Induced by Secretin: Distinctly Increased Response in Cirrhotics

The effect of secretin infusion on choleresis was studied in 3 patients with cirrhosis of the liver and 6 patients with no signs of liver disease. All patients had undergone biliary surgery with a balloon-equipped T-tube left in the common bile duct. In the cirrhotics, resting bile flow was slightly higher than in the control group. The response of hepatic bile to secretin infusion was markedly higher in the cirrhotics (5 to 10-fold). In addition, in patients with liver cirrhosis, secretin caused a pronounced increase of bicarbonate concentration with an equimolar fall in chloride concentration in the bile, while there was hardly any effect in this respect in the group with normal livers. The marked stimulatory effect of secretin on duodenal juice production in cirrhotics observed in earlier studies on exocrine pancreatic function can be explained by the high volume response of bile flow reported here. It is assumed that increased sensitivity of the bile duct epithelia in the cirrhotic liver to secretin stimulation is the most important factor for this effect.