Effects of jejunoileal bypass on the enterohepatic circulation of bile acids, bacterial flora in the upper small intestine, and absorption of vitamin B12

Fromm, Hans; Sarva, Rajendra P.; Ravitch, Mark M.; McJunkin, Brittain; Farivar, Sirus; Amin, Prafulla

doi:10.1016/0026-0495(83)90060-4

Cited by 15 publications

(7 citation statements)

References 36 publications

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“…Diarrheal states, including small bowel resections and jejunoileal bypass operation, are known to increase the proportion of the primary bile acids in the stools [32,33], probably because bacterial conversion of bile acids is limited in accelerated intestinal transit, as evidenced by the association be tween the secondary bile acid deoxycholic acid and intestinal transit time in our pa tients. Thus, the shift from secondary to pri mary fecal bile acids in the stools by ileal bypass was predictable.…”

Section: Discussionmentioning

confidence: 89%

Fecal and Biliary Bile Acid Composition after Partial Ileal Bypass Operation

Koivisto

1988

Digestion

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Biliary and fecal bile acid composition was studied in 13 patients 3–12 years after a partial ileal bypass operation and in 10 unoperated controls, all with heterozygous familial hypercholesterolemia. Three operated patients were taking cholestyramine. The relative amount of cholic acid in the bile was decreased at the expense of chenodeoxycholic acid in the operated subjects. Chenodeoxycholic acid content of the bile correlated negatively with the fractional cholesterol absorption, suggesting that in compromised absorption chenodeoxycholic acid is absorbed more efficiently than cholic acid. Despite a ninefold increase in total bile acid synthesis the cholic/chenodeoxycholic acid synthesis ratio was not significantly different in the operated and control subjects. However, the lower the chenodeoxycholic acid synthesis the higher was the proportion of deoxycholic acid in the bile and feces, suggesting regulation of chenodeoxycholic acid synthesis by deoxycholic acid. Ileal exclusion had increased the proportion of primary bile acids in the feces from below 10 to over 50%. Despite increased fecal water excretion the concentration of fecal total and dihydroxy bile acids was higher in the operated than in control subjects. However, the fecal concentration of the potentially cancer-promoting bile acids, deoxycholic acid and lithocholic acid, was not increased in the operated subjects. In the operated subjects, fecal water output was positively correlated with total bile acid and chenodeoxycholic acid synthesis. It is concluded that the severe bile acid malabsorption caused by ileal exclusion activates the synthesis of both primary bile acids in similar amount. However, after ileal exclusion the relative amount of cholic acid in the bile is decreased, obviously because loss of ileal absorption predominantly affects the absorption of cholic acid.

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Section: Discussionmentioning

confidence: 89%

Fecal and Biliary Bile Acid Composition after Partial Ileal Bypass Operation

Koivisto

1988

Digestion

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“…Early literature from clinical studies implicates the role of TGR5 in the prokinetic actions of BAs in the colon. Results from clinical trials testing the efficacy of UDCA and CDCA to dissolve and treat gallstones demonstrated that patients treated with CDCA, but not UDCA, experienced diarrhea as a side effect (158)(159)(160). Furthermore, constipation was relieved by treatment with CDCA, but not UDCA (159).…”

Section: Mechanisms For the Prokinetic Actions Of Ba And The Case For Tgr5mentioning

confidence: 99%

Contributions of bile acids to gastrointestinal physiology as receptor agonists and modifiers of ion channels

Keely

Urso

Ilyaskin

et al. 2022

American Journal of Physiology-Gastrointestinal and Liver Physi

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BAs are known to be important regulators of intestinal motility and epithelial fluid and electrolyte transport. Over the past two decades, significant advances in identifying and characterizing the receptors, transporters, and ion channels targeted by bile acids (BAs) has led to exciting new insights into the molecular mechanisms involved in these processes. Our appreciation of BAs, their receptors and BA-modulated ion channels as potential targets for the development of new approaches to treat intestinal motility and transport disorders is increasing. In the current review, we aim to summarize recent advances in our knowledge of the different BA receptors and BA-modulated ion channels present in the gastrointestinal system. We discuss how they regulate motility and epithelial transport, their roles in pathogenesis and their therapeutic potential in a range of gastrointestinal diseases.

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“…Studies in rats showed that bile delivered to the ileum, as opposed to the duodenum in intact rats, led to increased satiety hormone levels and weight loss, suggesting that the delivery of BA to the ileum in RYGB could be partly responsible for the metabolic effects observed [85]. Some studies also report an alteration in BA metabolism and its enterohepatic circulation after JIB [86,87]. BA have been shown to inhibit weight and adiposity gain in mice via increased thyroid-hormone mediated energy expenditure in brown adipose tissue and it is possible that this mechanism could be relevant to post-RYGB patients [88].…”

Section: Integrated Response To a Meal: Gastrointestinal Physiologmentioning

confidence: 99%

Gastrointestinal changes after bariatric surgery

Quercia¹,

Dutia²,

Kotler³

et al. 2014

Diabetes & Metabolism

102

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Severe obesity is a preeminent health care problem that impacts overall health and survival. The most effective treatment for severe obesity is bariatric surgery, an intervention that not only maintains long-term weight loss but also is associated with improvement or remission of several comorbidies including type 2 diabetes mellitus. Some weight loss surgeries modify the gastrointestinal anatomy and physiology, including the secretions and actions of gut peptides. This review describes how bariatric surgery alters the patterns of gastrointestinal motility, nutrient digestion and absorption, gut peptide release, bile acids and the gut microflora, and how these changes alter energy homeostasis and glucose metabolism.

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Effects of jejunoileal bypass on the enterohepatic circulation of bile acids, bacterial flora in the upper small intestine, and absorption of vitamin B12

Cited by 15 publications

References 36 publications

Fecal and Biliary Bile Acid Composition after Partial Ileal Bypass Operation

Fecal and Biliary Bile Acid Composition after Partial Ileal Bypass Operation

Contributions of bile acids to gastrointestinal physiology as receptor agonists and modifiers of ion channels

Gastrointestinal changes after bariatric surgery

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