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6,10,11 Surgical management can be considered if nonsurgical treatment is unsuccessful or the patient has rapidly progressive neurologic symptoms

Passage of bile acids through the enterocyte activates FXR, which promotes the synthesis of fibroblast growth factor 19 (FGF19), which also circulates through the portal vein to the liver where it activates fibroblast growth factor-receptor 4 resulting in inhibition of bile acid synthesis