Changes in the absorption of bile acids after total colectomy in patients with an ileostomy or pouch-anal anastomosis

Bile acid absorption was investigated using⁷⁵Se Taurohomocholate (SeHCAT) in controls and patients who had undergone total colectomy with either conventional ileostomy or pouch-anal anastomosis for ulcerative colitis or adenomatous polyposis. Whole-body retention of SeHCAT after 168 hours was greater in the controls than the patients who had undergone colectomy (P<.05). Retention of SeHCAT did not differ significantly between patients with an ileostomy and patients with pouch-anal anastomosis, but patients with an ileostomy and ileal resection of more than 20 cm retained less SeHCAT than patients with a pouch-anal anastomosis (P<.01). Analysis of fecal bile acids from ileostomies and pouches showed that bacterial metabolism of primary conjugated bile acids was greater in patients with a pouch. It was concluded that bile acid absorption was not significantly impaired by construction of a pouch compared with conventional ileostomy but bacterial metabolism of bile acids was greater in the pouches. Supported by a grant from the Yorkshire Regional Health Authority and was presented in part at the St. Mark's Hospital 150th Anniversary International Conference, May 29 to 31, 1985.