Skip to main content
PMC home page
Gut logoLink to Gut
. 1976 Apr;17(4):295–299. doi: 10.1136/gut.17.4.295

Relationship between bile acid malabsorption and pancreatic insufficiency in cystic fibrosis.

A M Weber, C C Roy, L Chartrand, G Lepage, O L Dufour, C L Morin, R Lasalle
PMCID: PMC1411100  PMID: 773791

Abstract

Bile acid loss (mg/m2 24h) in the stools of 43 cystic fibrosis (CF) children with pancreatic insufficiency was 751-1 +/- 48-3, while that of six without clinical evidence of pancreatic disease (133-4 +/- 15-9) did not differ from values in 25 controls (109-8 +/- 9-8). There was a good correlation between the degree of bile acid (BA) and fat sequestration. Concomitant changes in bile acid and fat loss were observed in the one group of six patients studied on and off pancreatic enzymes as well as in a second group of seven children treated with pancreatic supplements and maintained on a normal diet followed by a low fat diet supplemented with medium chain triglycerides. Administration of NA bicarbonate led to a significant decrease in fat loss (15-8 +/- 2-7 leads to 10-3 +/- 1-9) without any simultaneous change in bile acid excretion (533-1 +/- 58-3 leads to 500-4 +/- 58-6). Qualitative bile acid patterns in controls, in infants after an ileal resection, and in patients with CF or with coeliac disease showed that the percentage of primary BA followed closely the total amount excreted except in situations where antibiotics were administered. The exact mechanism for the increased loss of BA in CF is unknown. It is found in all age groups and is related to the presence and degree of pancreatic insufficiency. The possibility that unhydrolysed triglycerides may interfere with the intestinal absorption of bile acid needs further confirmation.

Full text

PDF
299

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ANNEGERS J. H. Function of pancreatic juice and of bile in assimilation of dietary triglyceride. AMA Arch Intern Med. 1954 Jan;93(1):9–22. doi: 10.1001/archinte.1954.00240250019002. [DOI] [PubMed] [Google Scholar]
  2. Ammon H. V., Phillips S. F. Inhibition of ileal water absorption by intraluminal fatty acids. Influence of chain length, hydroxylation, and conjugation of fatty acids. J Clin Invest. 1974 Jan;53(1):205–210. doi: 10.1172/JCI107539. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bonin A., Roy C. C., Lasalle R., Weber A., Morin C. L. Fecal chymotrypsin: a reliable index of exocrine pancreatic function in children. J Pediatr. 1973 Oct;83(4):594–600. doi: 10.1016/s0022-3476(73)80220-3. [DOI] [PubMed] [Google Scholar]
  4. Borgström B. Partition of lipids between emulsified oil and micellar phases of glyceride-bile salt dispersions. J Lipid Res. 1967 Nov;8(6):598–608. [PubMed] [Google Scholar]
  5. Eastwood M. A., Findlay J. M., Macrae R., Mitchell W. D. Why are primary bile acids present in cholerhoeic diarrhoea? Gut. 1972 Oct;13(10):845–846. [PubMed] [Google Scholar]
  6. Floch M. H., Gershengoren W., Elliott S., Spiro H. M. Bile acid inhibition of the intestinal microflora--a function for simple bile acids? Gastroenterology. 1971 Aug;61(2):228–233. [PubMed] [Google Scholar]
  7. Go V. L., Poley J. R., Hofmann A. F., Summerskill W. H. Disturbances in fat digestion induced by acidic jejunal pH due to gastric hypersecretion in man. Gastroenterology. 1970 May;58(5):638–646. [PubMed] [Google Scholar]
  8. Gracey M., Burke V., Anderson C. M. Medium chain triglycerides in paediatric practice. Arch Dis Child. 1970 Aug;45(242):445–452. doi: 10.1136/adc.45.242.445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. HEIZER W. D., CLEAVELAND C. R., IBER F. L. GASTRIC INACTIVATION OF PANCREATIC SUPPLEMENTS. Bull Johns Hopkins Hosp. 1965 Apr;116:261–270. [PubMed] [Google Scholar]
  10. Hofmann A. F., Poley J. R. Role of bile acid malabsorption in pathogenesis of diarrhea and steatorrhea in patients with ileal resection. I. Response to cholestyramine or replacement of dietary long chain triglyceride by medium chain triglyceride. Gastroenterology. 1972 May;62(5):918–934. [PubMed] [Google Scholar]
  11. Kattwinkel J., Agus S. G., Taussig L. M., Di Sant'Agnese P. A., Laster L. The use of L-arginine and sodium bicarbonate in the treatment of malabsorption due to cystic fibrosis. Pediatrics. 1972 Jul;50(1):133–137. [PubMed] [Google Scholar]
  12. Kuo P. T., Huang N. N. The effect of medium chain triglyceride upon fat absorption and plasma lipid and depot fat of children with cystic fibrosis of the pancreas. J Clin Invest. 1965 Nov;44(11):1924–1933. doi: 10.1172/JCI105298. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Mallory A., Kern F., Jr, Smith J., Savage D. Patterns of bile acids and microflora in the human small intestine. I. Bile acids. Gastroenterology. 1973 Jan;64(1):26–33. [PubMed] [Google Scholar]
  14. Redinger R. N., Hermann A. H., Small D. M. Primate biliary physiology. X. Effects of diet and fasting on biliary lipid secretion and relative composition and bile salt metabolism in the rhesus monkey. Gastroenterology. 1973 Apr;64(4):610–621. [PubMed] [Google Scholar]
  15. Ricour C., Rey J. Etude de l'hydrolyse et de la solubilisation micellaire des graisses par perfusion intestinale, chez l'enfant normal et au cours des déficits de sécrétion biliaire et lipasique. Arch Fr Pediatr. 1972 Jun-Jul;29(6):668–669. [PubMed] [Google Scholar]
  16. VEEGER W., ABELS J., HELLEMANS N., NIEWEG H. O. Effect of sodium bicarbonate and pancreatin on the absorption of vitamin B12 and fat in pancreatic insufficiency. N Engl J Med. 1962 Dec 27;267:1341–1344. doi: 10.1056/NEJM196212272672604. [DOI] [PubMed] [Google Scholar]
  17. Weber A. M., Chartrand L., Doyon G., Gordon S., Roy C. C. The quantitative determination of fecal bile acids in children by the enzymatic method. Clin Chim Acta. 1972 Jul;39(2):524–531. doi: 10.1016/0009-8981(72)90082-4. [DOI] [PubMed] [Google Scholar]
  18. Weber A. M., Roy C. C., Morin C. L., Lasalle R. Malabsorption of bile acids in children with cystic fibrosis. N Engl J Med. 1973 Nov 8;289(19):1001–1005. doi: 10.1056/NEJM197311082891903. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES