BILE ACID MALABSORPTION IN INFANTILE DIARRHEA

Abstract

Bile acid malabsorption (BAM) following ileal resection (IR) may cause watery (cholerheic) diarrhea and/or steatorrhea(S). BAM was evaluated in 15 such patients: a)short bowel syndrome after IR; b)idiopathic intractable diarrhea(ID)(prolonged, severe diarrhea from birth of unknown etiology) requiring hyperalimentation to maintain life; c)miscellaneous steatorrhea(MS) (isolated pancreatic insufficiency or hypobetalipoproteinemia) and d) chronic nonspecific diarrhea(CD) without S. Following an oral test meal containing 10 jμCi14C cholic acid(14C) and a nonabsorbable marker PEG stools were collected for calculation of a 14C:PEG excretion ratio. In 9 patients (MS+CD) with moderate diarrhea the mean loss of 14C (6%) and excretion ratio (.07) are in marked contrast to IR and ID patients. There was no difference between IR and ID groups. Ileal function (Schilling test + IF) was grossly abnormal (<1%) in 2 IR and both ID patients. The cause of BAM in ID may be due to diffuse ileal disease or to a specific bile acid transport defect. (Support: NIH GCRC RR-123)