POSTPRANDIAL CONJUGATED AND UNCONJUGATED SERUM BILE-ACID LEVELS AFTERPROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS

In patients with ileal pouch-anal anastomosis (IPAA) bile acid reabsor ption may be impaired, and stasis may lead to deconjugation and dehydr oxylation of bile acids as a result of bacterial overgrowth. We theref ore studied fasting and postprandial conjugated and unconjugated serum levels of cholic (CA), chenodeoxycholic (CDCA), and deoxycholic acid (DCA) in 11 patients who underwent proctocolectomy with IPAA and in 11 healthy controls. Fasting levels of conjugated DCA but not CA and CDC A were significantly lower in IPAA patients. Postprandially, conjugate d bile acid levels were significantly lower in IPAA patients. Postpran dial unconjugated CA levels were significantly higher and CDCA levels tended to be higher in IPAA patients, whereas unconjugated DCA levels were lower in IPAA patients. These data suggest that reabsorption of c onjugated bile acids is impaired after IPAA; deconjugation of bile aci ds may result from bacterial overgrowth secondary to stasis in the pou ch; and dehydroxylation of bile acids is decreased after proctocolecto my with IPAA.