Summary
Patients with ileectomy can present with severe steatorrhea due to bile acid depletion. While exogenous bile acid would seem to be ideal therapy for this condition, it is not often used because it is though that the bile acid would be malabsorbed and would enter the colon, producing a secretory diarrhea. This report describes a patient who had an ileectomy and partial right colon resection for Crohn's disease and then developed severe steatorrhea due to bile acid malabsorption. Although steatorrhea was reduced from 134 to 9 g/24 hr with chronic ingestion of ox bile extract, stool weight did not increase with ox bile (stool weight 669 g/24 hr before therapy and 507 g/24 hr after therapy). In this patient, oral bile acid supplementation reduced fat excretion markedly, but did not aggravate diarrhea, even though the colon was still present. This result may have been due to impaired solubility of bile acid in fecal fluid due to an acid pH or to binding of bile acid with particles of solid stool. Ingestion of ox bile extract does not necessarily increase stool weight in patients with defective fat absorption due to bile acid malabsorption and can be tried with caution in an effort to diminish steatorrhea.
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This work was supported by U.S. Public Health Service Grant 5-R01-DK37172-05 from the National Institute of Diabetes and Digestive and Kidney Diseases and by the Southwest Digestive Disease Foundation.
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Little, K.H., Schiller, L.R., Bilhartz, L.E. et al. Treatment of severe steatorrhea with ox bile in an ileectomy patient with residual colon. Digest Dis Sci 37, 929–933 (1992). https://doi.org/10.1007/BF01300393
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DOI: https://doi.org/10.1007/BF01300393