The Protean Manifestations of Crohn's Disease

Abstract

Clinically important metabolic consequences of ileal dysfunction secondary to inflammatory bowel disease, surgical bypass, or resection of inflamed bowel include gallstones, calcium oxalate nephrolithiasis, and diarrhea. At present not much can be done clinically to increase the bile salt pool reduced by ileal dysfunction. A reduction in dietary fat intake markedly decreases proximal intestinal hyperabsorption of dietary oxalate in patients with ileal resection and may be of value in patents with hyperoxaluria.

Diarrhea associated with excretion of less than 20 gm of fecal fat daily may be caused by a bile salt-induced impairment in colonic water and electrolyte transport: a gratifying clinical response may be observed when cholestyramine is administered. Medium-chain triglyceride substitution may become necessary to reduce diarrhea associated with clinically significant steatorrhea.—AR