title: Biliary sphincterotomy does not relate to diarrhoea or major changes in bile acid synthesis or plasma lipids.
abstract: OBJECTIVE
  Bile acid (BA) malabsorption may occur after cholecystectomy. Bile may flow more freely into the duodenum after endoscopic sphincterotomy (EST), in part resembling the situation after cholecystectomy. The (75)SeCHAT test used to diagnose BA malabsorption correlates inversely with synthesis and faecal excretion of BAs. The BA intermediate 7alpha-hydroxy-4-cholesten-3-one (C4) mirrors BA and lathosterol cholesterol synthesis. The aim was to study whether EST causes BA diarrhoea and alterations in BA synthesis or lipid profiles.
  
  
  METHODS
  Twelve patients underwent the (75)SeHCAT test prior to and 3 months after undergoing EST and a further 22 only after EST. The Gastrointestinal Symptom Rating Scale (GSRS), 1 week daily stool frequency and consistency, C4, lathosterol, cholesterol and triglycerides were investigated. The (75)SeHCAT values of 29 healthy subjects served as controls.
  
  
  RESULTS
  Stool frequency (median 1/day, IQR (interquartile range): 0.7) and consistency (median: 3, IQR: 0.65) were normal and none reported diarrhoea after EST (n=34). The GSRS scores were normal. There was no significant change in (75)SeHCAT (median 22%, IQR 29% versus 19.5%, IQR 25, n=12). There was a trend towards lower (75)SeHCAT after EST compared with the controls (median 26%, IQR 32, n=34 versus median 38%, IQR 19.5, n=29, p=0.075) and higher lathosterol (median 47.1 mg/mole, IQR 32.7 versus median 52.5 mg/mole, IQR 35.6, n=14, p=0.055). The C4 and lipids did not change significantly.
  
  
  CONCLUSIONS
  EST did not induce diarrhoea and in line with this BA synthesis and serum lipids are unaltered.
authors.affiliation: Department of Internal Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy Göteborg, Sweden. kjell-arne.ung@vgregion.se
authors.forename: Kjell-Arne
authors.initials: KA
authors.lastname: Ung
authors.forename: Nima
authors.initials: N
authors.lastname: Mottacki
authors.forename: Mats
authors.initials: M
authors.lastname: Rudling
authors.forename: Antal
authors.initials: A
authors.lastname: Bajor
mesh_terms: D000368:Aged; D001647:Bile Acids and Salts / Q000096:biosynthesis*; D016022:Case-Control Studies; D002783:Cholestenones; D003967:Diarrhea / Q000209:etiology*; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012644:Selenium Radioisotopes; D016717:Sphincterotomy, Endoscopic; D018709:Statistics, Nonparametric; D013656:Taurocholic Acid / Q000031:analogs & derivatives
chemical_list: D001647:Bile Acids and Salts; D002783:Cholestenones; D008055:Lipids; D012644:Selenium Radioisotopes; C002656:7 alpha-hydroxy-4-cholesten-3-one; D013656:Taurocholic Acid; C033638:23-seleno-25-homotaurocholic acid