TREATMENT OF SEVERE STEATORRHEA WITH OX BILE IN AN ILEECTOMY PATIENT WITH RESIDUAL COLON
TREATMENT OF SEVERE STEATORRHEA WITH OX BILE IN AN ILEECTOMY PATIENT WITH RESIDUAL COLON
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DOI：
10.1007/bf01300393
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发表时间：
1992-06-01
影响因子：
3.1
通讯作者：
FORDTRAN, JS
中科院分区：
文献类型：
--
作者：
LITTLE, KH;SCHILLER, LR;FORDTRAN, JS
回肠切除术患者可能因胆汁酸耗竭而出现严重的脂肪泻。虽然外源性胆汁酸似乎是治疗这种情况的理想疗法，但并不经常使用，因为胆汁酸会吸收不良并进入结肠，产生分泌性腹泻。本报告描述了一名因克罗恩病接受回肠切除术和部分右结肠切除术的患者，然后由于胆汁酸吸收不良而出现严重脂肪泻。虽然通过长期摄入牛胆汁提取物，脂肪泻从 134 克/24 小时减少到 9 克/24 小时，但粪便重量并没有随着牛胆汁的增加而增加（治疗前粪便重量为 669 克/24 小时，治疗后为 507 克/24 小时）。在该患者中，口服胆汁酸补充剂显着减少了脂肪排泄，但并未加重腹泻，尽管结肠仍然存在。该结果可能是由于酸性 pH 值或胆汁酸与固体粪便颗粒的结合导致胆汁酸在粪便中的溶解度受损。对于因胆汁酸吸收不良而导致脂肪吸收缺陷的患者，摄入牛胆汁提取物并不一定会增加粪便重量，因此可以谨慎尝试以减少脂肪泻。
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.