Acquired hyperoxaluria with regional enteritis after ileal resection. Role of dietary oxalate.

Abstract

Urinary oxalate excretion was measured in 11 patients with inflammatory bowel disease involving the terminal ileum. Group A consisted of six patients with minimal or no resection of terminal ileum and group B of six patients with resections greater than 30 cm. Basal urinary oxalate excretion was normal in group A but was significantly elevated in group B. After treatment with oral cholestyramine, a drug known to bind bile salts, urinary oxalate excretion fell promptly in group B to within the normal range but remained unchanged in group A. Five of six patients in group B had severe, explosive, watery diarrhea, which was dramatically reversed by cholestyramine. Hyperoxaluria in two patients was reversed when oxalate was removed from the diet, and in-vitro studies showed that cholestyramine binds oxalic acid. These data suggest that the mechanism of acquired hyperoxaluria in patients with ileal resection is related to enhanced absorption of dietary oxalate.