Conjugated bile acid replacement therapy for short-bowel syndrome

Background & Aims: Although fat malabsorption in the short-bower syndrome i s caused in part by decreased bile acid secretion, bile acid replacement th erapy is not used because of the belief that ingested bile acids would wors en diarrhea, outweighing the benefits of improved fat absorption. This stud y compared the effect of a natural conjugated bile acid mixture from ox bil e with that of cholylsarcosine, a synthetic conjugated bile acid, on fat ab sorption and diarrhea in a patient with the short-bower syndrome. Cholylsar cosine is resistant to bacterial metabolism and has no cathartic activity. Methods: Metabolic balance studies and a clinical trial were performed in a n emaciated patient with the short-bowel syndrome and ileostomy in whom par enteral nutrition could not be used. Results: In balance studies, conjugate d bile acid replacement therapy with either preparation caused fat absorpti on to increase by approximately 40 g/day, Calcium absorption also increased . Neither bile acid product caused a clinically significant increase in ile ostomy water output. During a 4-month outpatient trial, while the patient i ngested 2 g/meal natural bile acids, her weight increased from 80 to 98 lb, without side effects. Conclusions: Conjugated bile acid replacement therap y should be part of the armamentarium for the treatment of selected patient s with the short-bowel syndrome.