What is the Total Bile Acids (Bile Salts) test?

The Total Bile Acids test measures the concentration of bile acids circulating in the bloodstream. Bile acids are produced by the liver from cholesterol and are essential for digestion and absorption of fats and fat-soluble vitamins.

Under normal conditions, bile acids are efficiently recycled through the liver and intestines, with only small amounts entering the bloodstream. Elevated blood levels indicate impaired bile flow or liver dysfunction.

This test is particularly sensitive for detecting cholestasis, sometimes before standard liver enzymes become abnormal.

Why do I need a Total Bile Acids test?

Disruption in bile production or flow can cause symptoms and complications that may not be detected by routine liver tests alone.

You may need this test if you experience:

• Persistent or unexplained itching
• Jaundice (yellowing of skin or eyes)
• Right upper abdominal discomfort
• Abnormal liver function tests
• Suspected cholestatic liver disease
• Monitoring known liver or biliary conditions
• Symptoms of liver dysfunction with normal standard tests
• Pregnancy-related itching (suspected intrahepatic cholestasis of pregnancy)

Testing helps identify bile flow problems and supports earlier detection of liver-related conditions.

Benefits of the test

1. Sensitive marker of bile flow impairment
   Detects cholestasis earlier than routine liver enzymes.
2. Supports liver disease assessment
   Useful in chronic and acute liver conditions.
3. Important in pregnancy-related liver disorders
   Key test for suspected intrahepatic cholestasis of pregnancy.
4. Explains unexplained itching
   Elevated bile acids are a common cause.
5. Complements liver function tests
   Adds functional insight beyond standard markers.
6. Useful for disease monitoring
   Tracks progression or response over time.
7. Simple blood-based testing
   Requires only a blood sample.
8. Improves diagnostic confidence
   Helps clarify ambiguous liver test results.

Step-by-step: How we offer testing

Clinic-based testing (UK-wide)

• Choose your nearest UK clinic
• Attend your appointment
• A clinician draws a blood sample
• Sample is sent to the laboratory
• Results are issued once analysis is complete

Home or hotel visit (+£60, UK-wide)

• Book a mobile phlebotomist
• Blood sample taken at your home or hotel
• No need to attend a clinic
• Sample securely transported to the laboratory

Your results explained

Normal bile acids

• Bile acid levels within reference range
• UK standard (typical): <10 µmol/L
• Suggests normal bile production and flow

Mildly elevated bile acids

• Levels above reference range
• UK standard: 10–40 µmol/L
• May indicate early cholestasis or liver dysfunction

High bile acids

• Markedly elevated levels
• UK standard: >40 µmol/L
• Suggests significant bile flow impairment or liver disease

Interpretation should consider symptoms, pregnancy status, and other liver tests.