Enterohepatic circulation of bile acids in infants and children with ileal resection.
Seven children who had undergone ileal resection of varying lengths as neonates were studied to determine later gastrointestinal function with specific emphasis on the enterohepatic circulation of bile acids. Fecal homogenate and aqueous supernatant bile acid concentrations and serum bile acids were analyzed. Cholic acid kinetics were measured by the isotopic dilution technique, with multiple duodenal bile samples obtained within 48 hr after intravenous 14C--cholic acid. As compared to those of age-matched controls, significantly increased fecal homogenate bile acid concentrations (p less than 0.05) and fecal aqueous supernatant bile acid concentrations (p less than 0.01) were present. Fasting and postcibal serum bile acid concentrations were significantly reduced (p less than 0.001). Increased FTRs for cholic acid (p less than 0.001) were present in children with resection. The FTR correlated significantly with resection length (p = 0.012). Fasting pool sizes of chenodeoxycholic and cholic acid measured after an overnight fast were variable. Three children had significantly reduced cholic acid and chenodeoxycholic acid pools, and one had a reduction in the cholic acid pool only. The cholic acid pool size correlated directly with the postprandial rise in serum CG concentration (p = 0.003). The fecal coefficient of fat excretion and fecal weights were only moderately increased. Although rapid turnover of bile acids was present following neonatal ileal resection, efficient compensatory mechanisms during infancy and childhood allowed adequate intraluminal bile salt concentrations for normal fat solubilization throughout the day and resultant mild steatorrhea and diarrhea in our study patients.
D001647:Bile Acids and Salts / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D002793:Cholic Acids / Q000032:analysis; D004064:Digestive System / Q000503:physiopathology; D004764:Enterohepatic Circulation; D005243:Feces / Q000032:analysis; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000601:surgery*; D007082:Ileum / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D014805:Vitamin B 12 / Q000378:metabolism
D001647:Bile Acids and Salts; D002793:Cholic Acids; D002784:Cholesterol; D014805:Vitamin B 12