The profile of fecal bile acids was examined in 13 children with short
bowel syndrome; 7 of the 13 did not have diarrhea and the other 6 had
intractable diarrhea. In children without diarrhea, no severe fat mal
absorption was recognized, and the content of total bile acids in the
feces was within the normal range or slightly higher. The ratio of pri
mary to total bile acids showed various patterns. In children with int
ractable diarrhea, in contrast, fat malabsorption was observed and the
fecal content of total bile acids in these patients was more than ten
times higher than that of the control group, primary bile acids accou
nting for more than 95% of the total bile acids and taurine- or glycin
e-conjugated bile acids for 10%. In the children with intractable diar
rhea, the values for the D-xylose absorption test were lower than the
normal range. These results suggested that, in children with short bow
el syndrome with diarrhea. the loss of bile acids was strongly associa
ted with a decrease in the actual absorptive surface area of the resid
ual small intestine, and the growth of the normal bacterial flora was
disturbed in the residual intestine. Some children with or without dia
rrhea also had hyper bile acidemia, Ursodeoxycholic acid was not effec
tive for the treatment of hyper bile acidemia or fat malabsorption.