Abstract
The pathophysiology of cholerrheic enteropathy is described and a series of patients reviewed. Of 11 patients with chronic disabling diarrhea and steatorrhea after ileal resection or bypass, two had recurrent ileitis, three had lactose intolerance and six of those operated on five years or more previously had vitamin B12 deficiency. Cholestyramine was given alone or with medium-chain triglyceride (MCT) or Portagen (MCT and lactose). The maximal response occurred when cholestyramine was given with Portagen — significantly reduced stool frequency and weight in all patients and stool fat in five. Restudy of five patients four to 11 months later showed the same pattern of response: cholestyramine with 70% MCT abolished symptoms in four patients (ileectomy) and 100% MCT alone greatly improved the condition of the fifth (extensive small bowel resection).
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- Austad W. I., Lack L., Tyor M. P. Importance of bile acids and of an intact distal small intestine for fat absorption. Gastroenterology. 1967 Apr;52(4):638–646. [PubMed] [Google Scholar]
- BENSON J. A., Jr, CULVER P. J., RAGLAND S., JONES C. M., DRUMMEY G. D., BOUGAS E. The d-xylose absorption test in malabsorption syndromes. N Engl J Med. 1957 Feb 21;256(8):335–339. doi: 10.1056/NEJM195702212560802. [DOI] [PubMed] [Google Scholar]
- BOOTH C. C., MOLLIN D. L. The site of absorption of vitamin B12 in man. Lancet. 1959 Jan 3;1(7062):18–21. doi: 10.1016/s0140-6736(59)90979-1. [DOI] [PubMed] [Google Scholar]
- BORGSTROEM B., LUNDH G., HOFMANN A. THE SITE OF ABSORPTION OF CONJUGATED BILE SALTS IN MAN. Gastroenterology. 1963 Aug;45:229–238. [PubMed] [Google Scholar]
- Booth C. C., Alldis D., Read A. E. Studies on the site of fat absorption: 2 Fat balances after resection of varying amounts of the small intestine in man. Gut. 1961 Jun;2(2):168–174. doi: 10.1136/gut.2.2.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Forth W., Rummel W., Glasner H. Zur resorptionshemmenden Wirkung von Gallensäuren. Naunyn Schmiedebergs Arch Pharmakol Exp Pathol. 1966;254(4):364–380. [PubMed] [Google Scholar]
- HAWKINS C. F., MEYNELL M. J. Megaloblastic anaemia due to phenytoin sodium. Lancet. 1954 Oct 9;267(6841):737–738. doi: 10.1016/s0140-6736(54)90499-7. [DOI] [PubMed] [Google Scholar]
- HOFMANN A. F. THE FUNCTION OF BILE SALTS IN FAT ABSORPTION. THE SOLVENT PROPERTIES OF DILUTE MICELLAR SOLUTIONS OF CONJUGATED BILE SALTS. Biochem J. 1963 Oct;89:57–68. doi: 10.1042/bj0890057. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hardison W. G., Rosenberg I. H. Bile-salt deficiency in the steatorrhea following resection of the ileum and proximal colon. N Engl J Med. 1967 Aug 17;277(7):337–342. doi: 10.1056/NEJM196708172770704. [DOI] [PubMed] [Google Scholar]
- Heaton K. W., Austad W. I., Lack L., Tyor M. P. Enterohepatic circulation of C14-labeled bile salts in disorders of the distal small bowel. Gastroenterology. 1968 Jul;55(1):5–16. [PubMed] [Google Scholar]
- Heaton K. W., Read A. E. Gall stones in patients with disorders of the terminal ileum and disturbed bile salt metabolism. Br Med J. 1969 Aug 30;3(5669):494–496. doi: 10.1136/bmj.3.5669.494. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hofmann A. F., Poley J. R. Cholestyramine treatment of diarrhea associated with ileal resection. N Engl J Med. 1969 Aug 21;281(8):397–402. doi: 10.1056/NEJM196908212810801. [DOI] [PubMed] [Google Scholar]
- McLeod G. M., Wiggins H. S. Bile-salts in small intestinal contents after ileal resection and in other malabsorption syndromes. Lancet. 1968 Apr 27;1(7548):873–876. doi: 10.1016/s0140-6736(68)90235-3. [DOI] [PubMed] [Google Scholar]
- Meihoff W. E., Kern F., Jr Bile salt malabsorption in regional ileitis, ileal resection and mannitol-induced diarrhea. J Clin Invest. 1968 Feb;47(2):261–267. doi: 10.1172/JCI105722. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Richards A. J., Condon J. R., Mallinson C. N. Lactose intolerance following extensive small intestinal resection. Br J Surg. 1971 Jul;58(7):493–494. doi: 10.1002/bjs.1800580705. [DOI] [PubMed] [Google Scholar]
- Rubin C. E., Dobbins W. O., 3rd Peroral biopsy of the small intestine. A review of its diagnostic usefulness. Gastroenterology. 1965 Dec;49(6):676–697. [PubMed] [Google Scholar]
- SCHILLING R. F. Intrinsic factor studies II. The effect of gastric juice on the urinary excretion of radioactivity after the oral administration of radioactive vitamin B12. J Lab Clin Med. 1953 Dec;42(6):860–866. [PubMed] [Google Scholar]
- Sickinger K. The therapy of steatorrhoea with medium-chain triglycerides as a substitute for dietary fat. Ger Med Mon. 1969 Jun;14(6):308–310. [PubMed] [Google Scholar]
- Stanley M. M., Nemchausky B. Fecal C-14-bile acid excretion in normal subjects and patients with steroid-wasting syndromes secondary to ileal dysfunction. J Lab Clin Med. 1967 Oct;70(4):627–639. [PubMed] [Google Scholar]
- Thompson W. G. Cholestyramine. Can Med Assoc J. 1971 Feb 20;104(4):305–309. [PMC free article] [PubMed] [Google Scholar]
- VOGEL W. C., ZIEVE L. Simplification in the measurement of total fecal fat. Am J Clin Pathol. 1961 Nov;36:474–475. doi: 10.1093/ajcp/36.5_ts.474. [DOI] [PubMed] [Google Scholar]