Bile acid malabsorption or disturbed intestinal permeability in patients treated with enzyme substitution for exocrine pancreatic insufficiency is not caused by bacterial overgrowth.
BACKGROUND
In some patients with severe exocrine pancreatic insufficiency, enzyme replacement therapy will not lead to clinical improvement or reduction of steatorrhea. Therefore, other mechanisms separately or in interplay with reduced enzyme secretion might be responsible for malabsorption in these patients.


OBJECTIVE
To evaluate the prevalence of bacterial overgrowth, bile acid absorption capacity, and intestinal permeability in a group of patients with well-characterized exocrine pancreatic insufficiency.


METHODS
Eleven men with severe exocrine pancreatic insufficiency, of whom 10 were receiving enzyme replacement therapy, were studied. The prevalence of bacterial overgrowth was evaluated by means of a hydrogen and methane breath test with glucose. Gamma camera scintigraphy after intake of 75Se-homocholic acid taurine (75Se-HCAT) was used to evaluate bile acid absorption capacity. Intestinal permeability was assessed from urine excretion of ingested 14C-mannitol and 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA), and these data were compared with results for 10 age-matched healthy men.


RESULTS
No patients had abnormal breath hydrogen or methane concentrations after glucose intake. Abdominal retention of 75Se-HCAT was reduced in three of the patients. The patients had lower urine excretion of 14C-mannitol than the control subjects, whereas no difference was revealed in urine excretion of 99mTc-DTPA.


CONCLUSIONS
Bile acid absorption and small intestinal permeability might be affected in patients with exocrine pancreatic insufficiency who receive treatment with enzyme supplementation. The prevalence of bacterial overgrowth seems to be low among these patients and does not explain the findings.
Madsen
Jan Lysgård
JL
Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Denmark. jan.lysgaard.madsen@hh.hosp.dk
Graff
Jesper
J
Philipsen
Else Kirstine
EK
Scharff
Ole
O
Rumessen
Jüri Johannes
JJ
D000328:Adult; D001424:Bacterial Infections / Q000382:microbiology; D001647:Bile Acids and Salts / Q000378:metabolism*; D001944:Breath Tests / Q000379:methods; D002908:Chronic Disease; D057487:Enzyme Therapy; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism*; D007422:Intestines / Q000382:microbiology / Q000503:physiopathology; D008286:Malabsorption Syndromes / Q000378:metabolism; D008297:Male; D008353:Mannitol / Q000652:urine; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications; D010539:Permeability / Q000187:drug effects
D001647:Bile Acids and Salts; D008353:Mannitol