Bile acid dysmetabolism is characterized by what in the study?

• A. Increased proportion of primary bile acids in the feces
• B. Decreased total bile acids
• C. Increased secondary bile acids in feces
• D. No change in bile acids

Answer: (A)

Bile acids are made in the liver as primary bile acids and then transformed by gut bacteria into secondary bile acids. When bile acid metabolism is disrupted, the usual conversion from primary to secondary can be impaired, so more primary bile acids are excreted in the feces. Seeing an increased proportion of primary bile acids in feces therefore points to dysmetabolism, reflecting altered microbial processing or enterohepatic handling rather than a simple drop in total bile acids or an increase in secondary acids. In other words, the pattern indicates a shift toward primaries due to disrupted conversion, which is what the study highlighted.