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Bile acid absorption after near-total proctocolectomy in dogs: Ileal pouch vs. jejunal pouch-distal rectal anastomosis

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Journal of Gastrointestinal Surgery

Abstract

Bile acid malabsorption is often present in patients after near-total proctocolectomy and ileal pouchanal canal anastomosis, suggesting ileal dysfunction. Experiments were performed in dogs to compare bile acid absorption after a modified procedure, in which a jejunal pouch was interposed between the terminal ileum and the distal rectum, with that after a conventional ileal pouch operation. Fecal bile acid output (equivalent to hepatic bile acid biosynthesis) and composition were determined by gas chromatography/mass spectrometry in five jejunal pouch dogs and in five ileal pouch dogs more than 6 months after operation. Fecal bile acid output in the jejunal pouch dogs (mean +standard deviation) was 215 ±59 mg/day(10.1 ±2.7 mg/kg-day), a value similar to that obtained in the ileal pouch dogs (261 ±46mg/day [12.8 ±3.1 mg/kg-day]; P >0.05). These values were also similar to those reported by others for healthy unoperated dogs, indicating that increased bile acid biosynthesis occurring in response to bile acid malabsorption was not present. Fecal bile acids in pouch dogs were completely deconjugated and extensively 7-dehydroxylated (jejunal pouch = 90.4% ±3.9% dehydroxylated; ileal pouch = 88.6% ±6.6% dehydroxylated) and consisted predominantly of deoxycholic acid derivatives. We conclude that when either a jejunal pouch or an ileal pouch is used as a rectal substitute in dogs, an anaerobic pouch flora develops that efficiently deconjugates and dehydroxylates bile acids, rendering them membrane permeable. The resultant passive absorption of unconjugated bile acids appears to compensate for any loss of active ileal absorption of conjugated bile acids, and bile acid malabsorption does not occur.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic Scottsdale, 85259, Scottsdale, Ariz

    Fabio V. Teixeira M.D., Miguél Pera M.D. & Keith A. Kelly M.D.

  2. Division of Gastroenterology, Department of Medicine, University of California-San Diego, La Jolla, Calif.

    Alan F. Hofmann M.D. & Lee R. Hagey Ph.D.

  3. Zoological Society of San Diego, San Diego, Calif.

    Lee R. Hagey Ph.D.

Authors
  1. Fabio V. Teixeira M.D.
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  2. Alan F. Hofmann M.D.
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  3. Lee R. Hagey Ph.D.
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  4. Miguél Pera M.D.
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  5. Keith A. Kelly M.D.
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Correspondence to Keith A. Kelly M.D..

Additional information

Supported by the Mayo Foundation and the Ministry of Education and Sport, Brasilia, Brazil; National Institutes of Health grant DK 37172; a grant-in-aid from the Falk Foundation e.V., Freiburg, Germany; and the Zoological Society of San Diego.

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Teixeira, F.V., Hofmann, A.F., Hagey, L.R. et al. Bile acid absorption after near-total proctocolectomy in dogs: Ileal pouch vs. jejunal pouch-distal rectal anastomosis. J Gastrointest Surg 5, 540–545 (2001). https://doi.org/10.1016/S1091-255X(01)80093-7

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  • DOI: https://doi.org/10.1016/S1091-255X(01)80093-7

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