DISORDER OF BILE-ACID METABOLISM IN CHILDREN WITH SHORT-BOWEL SYNDROME

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.