Sulfation of bile acids, catalyzed by SULT2A1, increases their solubility and decreases intestinal absorption, thus enhancing BA detoxification and excretion.4,6 Importantly, SULT2A1 expression is upregulated by PPARα, which was increased in our CLD samples.4,6 Therefore, these sulfated bile acids may be more numerous or variable in our CLD samples. Here, PPARA is linked to congenital secretory chloride diarrhea 1.