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It is clear that a truly spectacular increase in our understanding of the biliary circulation has occurred during the past 5 years. A steady-state situation has now become dynamic. In a sense, we have clarified the anatomy and physiology of the biliary circulation, and the challenge now is to describe its biochemistry. Specifically, we remain totally ignorant of the mechanism of cell transport of bile acids, the regulation of their synthesis and the action of bile acids in bile formation. When we understand the biliary circulation, we can then clarify its diseases. That, in turn, should lead to the development of a new specialty of biliary therapy.
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