Conjugated Bile Acid Replacement Therapy in Short Bowel Syndrome Patients with a Residual Colon

 

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Zusammenfassung

Ziel: Das Studienziel war, die Wirksamkeit von Cholylsarkosin (synthetische konjugierte Gallensäure) und von Rindergalleextrakten (Mischung natürlicher konjugierter Gallensäuren) auf Fettresorption, Diarrhö und Ernährungszustand bei vier Patienten mit Kurzdarmsyndrom und erhaltenem Kolon, die nicht von parenteraler Ernähung abhängig sind, zu testen. Methoden: Der Effekt von Cholylsarkosin (2 g/Mahlzeit) auf Steatorrhö und Diarrhö wurde in bilanzierten Kurzzeitstudien mit konstanter Fettzufuhr bei allen vier Patienten getestet. Der Effekt von kontinuierlicher Einnahme von Cholylsarkosin auf den Ernährungszustand, der in Form des Körpergewichts gemessen wurde, wurde bei drei Patienten getestet. Bei zwei Patienten wurde der Effekt von Cholylsarkosin mit dem der Rindergalleextrakte verglichen. Aufgrund der niedrigen Inzidenzrate des Kurzdarmsyndroms handelt es sich hier um keine kontrollierte Studie. Ergebnisse: In bilanzierten Studien steigerte Cholylsarkosin die Fettresorption von 65,5 auf 94,5 g/Tag (Zunahme um 44 %), ein Energiezugewinn von 261 kcal/Tag. Das Stuhlgewicht nahm um 26 % zu. Bei zwei Patienten reduzierten natürliche konjugierte Gallensäuren die Steatorrhö ebenfalls, verschlechterten aber die Diarrhö. Auf ambulanter Basis ohne diätetische Einschränkungen konnte bei drei Patienten unter Cholylsarkosineinnahme eine durchschnittliche Gewichtszunahme von 0,9 kg pro Woche erzielt werden, wobei es zu keiner Verschlechterung der Diarrhö kam. Schlussfolgerungen: Cholylsarkosin führt zu einer Verbesserung der Fettresorption und des Ernährungszustandes bei Patienten mit Kurzdarmsyndrom und erhaltenem Kolon und ist sicher in der Anwendung. Natürliche konjugierte Gallensäuren verbessern die Fettresorption in geringerem Ausmaß und verschlechtern die Diarrhö.

Abstract

Aim: To test the efficacy of cholylsarcosine (synthetic conjugated bile acid) and ox bile extracts (mixture of natural conjugated bile acids) on fat absorption, diarrhea, and nutritional state in four short bowel syndrome (SBS) patients with a residual colon not requiring parenteral alimentation. Methods: The effect of cholylsarcosine (2 g/meal) on steatorrhea and diarrhea was examined in short-term balance studies with a constant fat intake in all four patients. The effect of continuous cholylsarcosine ingestion on nutritional state was assessed by changes in body weight in three patients. In two patients, the effects of cholylsarcosine were compared with those of ox bile extracts. Because of the low incidence rate of SBS this is not a controlled study. Results: In balance studies, cholylsarcosine increased fat absorption from 65.5 to 94.5 g/day (a 44 % increment), an energy gain of 261 kcal/d. Fecal weight increased by 26 %. In two patients natural conjugated bile acids also reduced steatorrhea, but greatly increased diarrhea. As outpatients consuming an unrestricted diet and ingesting cholylsarcosine, three patients gained weight at an average rate of 0.9 kg/week without worsening of diarrheal symptoms. Conclusions: Cholylsarcosine is efficacious and safe for enhancing fat absorption and nutritional status in short bowel syndrome patients with residual colon. Natural conjugated bile acids improve steatorrhea to a smaller extent and greatly worsen diarrhea.

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Dr. Christine Kapral

KH Barmherzige Brüder

Seilerstätte 2

4021 Linz

Austria

Email: christine.kapral@bblinz.at