Normal or increased bile acid uptake in isolated mucosa from patients with bile acid malabsorption.
BACKGROUND
Bile acid malabsorption as reflected by an abnormal Se-labelled homocholic acid-taurine (SeHCAT) test is associated with diarrhoea, but the mechanisms and cause-and-effect relations are unclear.


OBJECTIVE
Primarily, to determine whether there is a reduced active bile acid uptake in the terminal ileum in patients with bile acid malabsorption. Secondarily, to study the linkage between bile acid malabsorption and hepatic bile acid synthesis.


METHODS
Ileal biopsies were taken from patients with diarrhoea and from controls with normal bowel habits. Maximal active bile acid uptake was assessed in ileal biopsies using a previously validated technique based on uptake of C-labelled taurocholate. To monitor the hepatic synthesis, 7alpha-hydroxy-4-cholesten-3-one, a bile acid precursor, was assayed in blood. The SeHCAT-retention test was used to diagnose bile acid malabsorption.


RESULTS
The taurocholate uptake in specimens from diarrhoea patients was higher compared with the controls [median, 7.7 (n=53) vs 6.1 micromol/g per min (n=17)] (P<0.01) but no difference was seen between those with bile acid malabsorption (n=18) versus diarrhoea with a normal SeHCAT test (n=23). The SeHCAT values and 7alpha-hydroxy-4-cholesten-3-one were inversely correlated.


CONCLUSIONS
The data do not support bile acid malabsorption being due to a reduced active bile acid uptake capacity in the terminal ileum.
Division of Gastroenterology, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
Antal
A
Bajor
Anders
A
Kilander
Anita
A
Fae
Cecilia
C
Gälman
Olof
O
Jonsson
Lena
L
Ohman
Mats
M
Rudling
Henrik
H
Sjövall
Per-Ove
PO
Stotzer
Kjell-Arne
KA
Ung
D000328:Adult; D001647:Bile Acids and Salts / Q000378:metabolism*; D016022:Case-Control Studies; D003967:Diarrhea / Q000378:metabolism; D005260:Female; D006801:Humans; D007082:Ileum / Q000378:metabolism*; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism; D008286:Malabsorption Syndromes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D013656:Taurocholic Acid / Q000378:metabolism
D001647:Bile Acids and Salts; D013656:Taurocholic Acid