Excretion, Deconjugation, and Absorption of Bile Acids after Colectomy for Ulcerative Colitis: Comparative Studies in Patients with Conventional Ileostomy and Patients with Kock's Reservoir

Abstract

Bile acid metabolism was studied in 26 patients with a continent ileostomy (Kock's reservoir) and 32 patients with conventional ileostomy. All had been colectomized for ulcerative colitis. In patients with a continent ileostomy the ¹⁴C-glycocholic acid breath test showed increased pulmonary ¹⁴CO₂ excretion as evidence of abnormal bacterial deconjugation of bile acids and increased faecal ¹⁴C excretion as evidence of bile acid malabsorption. Faecal bile acid excretion, determined chemically, and, by inference, bile acid synthesis were only moderately increased (median, 1.8 mmol/ day). The disturbance of bile acid metabolism was similar to that found in 32 patients with conventional ileostomy, but more pronounced with higher faecal ¹⁴C. A significant difference was that no abnormal bacterial deconjugation took place in patients with conventional ileostomy, since their pulmonary ¹⁴CO₂ excretion was subnormal. Stool mass was almost identical in the two groups, with median values of 665 and 663 g/day, respectively. Faecal fat excretion was normal in most in both groups. Thus bile acid metabolism is slightly more disturbed in patients with a continent ileostomy than in patients with conventional ileostomy. The resulting malabsorption was modest in both groups.

Key Words:

• Continent ileostomy
• conventional ileostomy
• faecal bile acid excretion
• ¹⁴C-glycocholic acid breath test
• Kock's reservoir
• ulcerative colitis