Test Catalog

Test ID: BILEA    
Bile Acids, Total, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

An aid in the evaluation of liver function


Evaluation of liver function changes before the formation of more advanced clinical signs of illness such as icterus


An aid in the determination of hepatic dysfunction as a result of chemical and environmental injury


An indicator of hepatic histological improvement in chronic hepatitis C patients responding to interferon treatment


An indicator for intrahepatic cholestasis of pregnancy

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Bile acids are formed in the liver from cholesterol, conjugated primarily to glycine and taurine, stored and concentrated in the gallbladder, and secreted into the intestine after the ingestion of a meal. In the intestinal lumen, the bile acids serve to emulsify ingested fats and thereby promote digestion. During the absorptive phase of digestion, approximately 90% of the bile acids are reabsorbed.


The efficiency of the hepatic clearance of bile acids from portal blood maintains serum concentrations at low levels in normal persons. An elevated fasting level, due to impaired hepatic clearance, is a sensitive indicator of liver disease. Following meals, serum bile acid levels have been shown to increase only slightly in normal persons but markedly in patients with various liver diseases, including cirrhosis, hepatitis, cholestasis, portal-vein thrombosis, Budd-Chiari syndrome, cholangitis, Wilson disease, and hemochromatosis. No increase in bile acids will be noted in patients with intestinal malabsorption. Metabolic hepatic disorders involving organic anions (eg, Gilbert disease, Crigler-Najjar syndrome, and Dubin-Johnson syndrome) do not cause abnormal serum bile acid concentrations.


Significant increases in total bile acids in nonfasting pregnant females can aid in the diagnosis of cholestasis. Other factors, such as complete medical history, physical exam, and liver function tests should also be considered.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

< or =10 mcmol/L


Reference interval applies to fasting total bile acid concentrations.

Interpretation Provides information to assist in interpretation of the test results

Total bile acids are metabolized in the liver and can serve as a marker for normal liver function.

Increases in serum bile acids are seen in patients with acute hepatitis, chronic hepatitis, liver sclerosis, and liver cancer.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Serum total bile acid testing is generally not suitable for differentiation among the various types of liver diseases.


Total bile acid concentration is increased after meals; samples should be collected under fasting conditions.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Sawkat Anwer M, Meyer DJ: Bile Acids in the diagnosis, pathology, and therapy of hepatobiliary diseases. Vet Clin North Am Small Anim Pract. 1995 March;25(2):503-517

2. Javitt NB: Diagnostic value of serum bile acids. Clin Gastroenterol. 1977;6:219-226

3. Osuga T, Mitamura K, Mashige F, et al: Evaluation of fluorimetrically estimated serum bile acid in liver disease. Clin Chim Acta. 1977;75:81-90

4. Shima T, Tada H, Morimoto M, et al: Serum total bile acid level as a sensitive indicator of hepatic histological improvement in chronic hepatitis C patients responding to interferon treatment. J Gastroenterol Hepatol. 2000 March;15(30):294-299

5. Lebovics E, Seif F, Kim D, et al: Pruritus in chronic hepatitis C: Association with high serum bile acids, advanced pathology, and bile duct abnormalities. Dig Dis Sci. 1997 May;42(5):1094-1099

6. Korman MG, Hofmann AF, Summerskill WHJ: Assessment of activity in chronic active liver disease. Serum bile acids compared with conventional tests and histology. NEJM 1974 June 20;290:1399-1402

7. Manzotti C, Casazza G, Stimac T, Nikolova D, Gluud C. Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy. Cochrane Database Syst Rev. 2019 Jul 5;7(7):CD012546. doi: 10.1002/14651858.CD012546.pub2

Special Instructions Library of PDFs including pertinent information and forms related to the test