Bile acid dysfunction after clam enterocystoplasty.
OBJECTIVE
To determine if the bowel dysfunction that develops in approximately 12% of patients after a clam enterocystoplasty is due to disruption of the enterohepatic circulation of bile acids.


METHODS
Fourteen symptomatic patients (mean age 36 years, range 21-65) who had undergone clam enterocystoplasty were investigated by bowel frequency charts, hydrogen breath tests of expired air and the retention of radioactive 75Se-labelled homocholic acid-taurine (SeHCAT), a synthetic bile acid. Patients with abnormal results were commenced on anion-exchange resins and the symptoms evaluated 6 weeks later.


RESULTS
The interruption of bile acid circulation, as estimated by SeHCAT, occurred in most of the patients studied and was due to surgical resection of the terminal ileum. All hydrogen breath tests were normal, excluding bacterial overgrowth as a cause of diarrhoea. Bowel frequency correlated well with the percentage of SeHCAT retained. Anion-exchange resins were successful in relieving the symptoms if patients complied well with the treatment.


CONCLUSIONS
After clam enterocystoplasty, some patients have bowel dysfunction caused by the interruption of the enterohepatic circulation of bile acids. These patients can be identified using bowel frequency charts and treated by anion-exchange resins.
Barrington
J W
JW
Department of Urology, Cardiff Royal Infirmary, UK.
Fern-Davies
H
H
Adams
R J
RJ
Evans
W D
WD
Woodcock
J P
JP
Stephenson
T P
TP
D000328:Adult; D000368:Aged; D001647:Bile Acids and Salts; D001944:Breath Tests; D003967:Diarrhea / Q000209:etiology*; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D007475:Ion Exchange Resins / Q000627:therapeutic use; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D001743:Urinary Bladder / Q000601:surgery*
D001647:Bile Acids and Salts; D007475:Ion Exchange Resins