Diagnostic determination system for high-risk screening for inborn errors of bile acid metabolism based on an analysis of urinary bile acids using gas chromatography-mass spectrometry: Results for 10 years in Japan

• Published in: Pediatrics international Vol. 51; no. 4; pp. 535 - 543
• Main Authors: Nittono, Hiroshi, Takei, Hajime, Unno, Atsushi, Kimura, Akihiko, Shimizu, Toshiaki, Kurosawa, Takao, Tohma, Sadahiko, Une, Mizuho
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.08.2009; Blackwell Publishing Ltd
• Subjects: Adolescent; Adult; Bile; Bile Acids and Salts - metabolism; Bile Acids and Salts - urine; Child; cholestasis; Cholestasis - etiology; Cholestasis - metabolism; Female; Gas Chromatography-Mass Spectrometry; GC-MS; Humans; inborn errors of bile acid metabolism; Infant; Infant, Newborn; Medical diagnosis; Medical disorders; Metabolism; screening; Smith-Lemli-Opitz Syndrome - diagnosis; Steroid Metabolism, Inborn Errors - diagnosis; urinary bile acid; Young Adult; Zellweger Syndrome - diagnosis; Japan
• ISSN: 1328-8067; 1442-200X; 1442-200X
• DOI: 10.1111/j.1442-200X.2008.02799.x

Background:  Some patients with cholestasis of unknown cause may have inborn errors of bile acid metabolism (IEBAM) thus causing abnormalities of bile acid biosynthesis. Although seven types of bile acid synthetic defects have thus far been reported for this disorder, no detailed information on its incidence and so on in Japan is yet available. In order to elucidate the current status of IEBAM in Japan, in July 1996 a diagnostic determination system was established for high‐risk screening for IEBAM. Methods:  Urinary bile acids were analyzed on gas chromatography–mass spectrometry (GC‐MS) and quantitative analysis was done using selected ion monitoring (SIM). Results and conclusions:  In a total of 576 samples analyzed over the 10 year period prior to June 2005, 159 patients were found with cholestasis of unknown etiology. Of these patients, 10 (6.3%) were found to have IEBAM by this system, while 91 (61.1%) had cholestasis without a definitive diagnosis. This diagnostic determination system with GC‐MS of urinary bile acids is therefore considered useful for detecting IEBAM.