Microbial Flora and Bile Acid Metabolism in Patients with an Ileal Reservoir

Abstract

Go PMNYH, van Dieijen-Visser MP, Davies BI, Lens J, Brombacher PJ. Microbial flora and bile acid metabolism in patients with an ileal reservoir.

Bacterial flora of ileum effluent and bile acid metabolism were investigated in 11 patients 11-44 months after construction of a Kock' continent ileostomy. Bacteriologic investigation showed significantly more microorganisms per millilitre (p < 0.01) and a more colon-like flora—that is, anaerobic microorganisms (p < 0, 001)—in ileum effluent of continent ileostomy patients than in ileum effluent of patients with a conventional ileostomy. The reabsorptive capacity of the reservoir mucosa was tested by direct introduction of a radioactively labelled conjugated bile acid, 23-⁷⁵Se-25–homotaurocholic acid (SeHCAT), into the ileal pouch. After 4h, 90% of the SeHCAT activity had been reabsorbed from the reservoir. Quantitative and differential analysis of bile acids in the ileum effluent showed unconjugated and predominantly primary (88%) bile acids, suggesting a minimal influence of bacterial flora on bile acid metabolism. Moreover, total bile acid loss appeared to be within normal limits.

Key Words:

• Bile acid metabolism
• continent ileostomy
• ileal effluent
• ileal mucosa
• ileal reservoir
• Kock' ileostomy
• microbial flora
• SeHCAT