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The two primary bile salts, cholic acid and chenodeoxycholic acid, are synthesized in the hepatocyte from cholesterol. They are conjugated with the amino acids glycine or taurine prior to their secretion into bile. Most of these are reabsorbed in the small intestine and recirculated to the liver (enterohepatic circulation [EHC]).
The bile salts that are not absorbed pass to the distal ileum and colon, where anerobic bacteria enzymatically deconjugate and then remove the 7a -hydroxy group from the primary bile salts, yielding the two secondary bile salts which also undergo EHC. One of these (deoxycholate, formed from cholate) is readily absorbed from the colon and re-excreted in a conjugated form by the liver. The other secondary bile salt (lithocholate, formed from chenodeoxycholate) is poorly absorbed; the small fraction absorbed is efficiently conjugated and sulphated by the human liver and then excreted in bile and lost from the body in the feces. The secondary bile salts, especially when deconjugated, are more hydrophobic and toxic than the corresponding primary bile salts from which they are derived.
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