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

Kapral, C; Wewalka, F; Praxmarer, V.; Lenz, Kristina; Hofmann, Alan F.

doi:10.1055/s-2004-813059

Cited by 33 publications

(18 citation statements)

References 28 publications

(22 reference statements)

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“…In such patients, administration of desiccated bile improved steatorrhea, but greatly worsened diarrhea. Cholylsarcosine improved fat absorption but, in contrast to desiccated bile, induced little change in fecal weight [98]. Cholylsarcosine no longer has patent protection and may never be brought to market.…”

Section: Bile Acid Replacementmentioning

confidence: 99%

Bile Acids: Chemistry, Pathochemistry, Biology, Pathobiology, and Therapeutics

Hofmann

Hagey

2008

Cell. Mol. Life Sci.

712

565

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Bile acids and bile alcohols in the form of their conjugates are amphipathic end products of cholesterol metabolism with multiple physiological functions. The great variety of bile acids and bile alcohols that are present in vertebrates are tabulated. Bile salts have an enterohepatic circulation resulting from efficient vectorial transport of bile salts through the hepatocyte and the ileal enterocyte; such transport leads to the accumulation of a pool of bile salts that cycles between the liver and intestine. Bile salt anions promote lipid absorption, enhance tryptic cleavage of dietary proteins, and have antimicrobial effects. Bile salts are signaling molecules, activating nuclear receptors in the hepatocyte and ileal enterocyte, as well as an increasing number of G-protein coupled receptors. Bile acids are used therapeutically to correct deficiency states, to decrease the cholesterol saturation of bile, or to decrease the cytotoxicity of retained bile acids in cholestatic liver disease.

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Section: Bile Acid Replacementmentioning

confidence: 99%

Bile Acids: Chemistry, Pathochemistry, Biology, Pathobiology, and Therapeutics

Hofmann

Hagey

2008

Cell. Mol. Life Sci.

712

565

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“…In patients with ileal resections and steatorrhea but with intact colons, cholylsarcosine increased fat absorption and patients gained weight. 72 However, our use patent was not licensed, and the compound is now in the public domain, precluding its commercial development. The inability to bring cholylsarcosine to the market is one of my failures.…”

Section: Bile Acid Metabolism In Short Bowel Syndromementioning

confidence: 99%

Bile acids: Trying to understand their chemistry and biology with the hope of helping patients

2008

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An informal review of the author's five decades of research on the chemistry and biology of bile acids in health and disease is presented. The review begins with a discussion of bile acid structure and its remarkable diversity in vertebrates. Methods for tagging bile acids with tritium for metabolic or transport studies are summarized. Bile acids solubilize polar lipids in mixed micelles; progress in elucidating the structure of the mixed micelle is discussed. Extensive studies on bile acid metabolism in humans have permitted the development of physiological pharmacokinetic models that can be used to simulate bile acid metabolism. Consequences of defective bile acid biosynthesis and transport have been clarified, and therapy has been developed. Methods for measuring bile acids have been improved. The rise and fall of medical and contact dissolution of cholesterol gallstones is chronicled. Finally, principles of therapy with bile acid agonists and antagonists are given. Advances in understanding bile acid biology and chemistry have helped to improve the lives of patients with hepatobiliary or digestive disease.

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“…Interestingly, it may be feasible to increase UDCA intestinal exposure by the use of a specific type of probiotic (living bacteria) that epimerizes CDCA to UDCA within the intestinal lumen [134] . BAs have been used in some cases as a replacement to reduce steatorrhea due to short bowel syndrome or secondary to metabolic genetic diseases, frequently at the price of enhanced diarrhea [135,136] . Conversely, diarrhea without steatorrhea benefits from treatment with ion exchange www.wjgnet.com resins such as cholestiramine that bind and act as sequestrant of BAs during their intestinal transit [137] .…”

Section: Intestinal Applications Of Bamentioning

confidence: 99%

Intestinal bile acid physiology and pathophysiology

Martínez‐Augustin¹,

Medina²

2008

WJG

135

114

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Bile acids (BAs) have a long established role in fat digestion in the intestine by acting as tensioactives, due to their amphipathic characteristics. BAs are reabsorbed very efficiently by the intestinal epithelium and recycled back to the liver via transport mechanisms that have been largely elucidated. The transport and synthesis of BAs are tightly regulated in part by specific plasma membrane receptors and nuclear receptors. In addition to their primary effect, BAs have been claimed to play a role in gastrointestinal cancer, intestinal inflammation and intestinal ionic transport. BAs are not equivalent in any of these biological activities, and structural requirements have been generally identified. In particular, some BAs may be useful for cancer chemoprevention and perhaps in inflammatory bowel disease, although further research is necessary in this field. This review covers the most recent developments in these aspects of BA intestinal biology.

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

Abstract: 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.

Cited by 33 publications

References 28 publications

Bile Acids: Chemistry, Pathochemistry, Biology, Pathobiology, and Therapeutics

Bile Acids: Chemistry, Pathochemistry, Biology, Pathobiology, and Therapeutics

Bile acids: Trying to understand their chemistry and biology with the hope of helping patients

Intestinal bile acid physiology and pathophysiology

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