Enteric Hyperoxaluria: Dependence on Small Intestinal Resection, Colectomy, and Steatorrhoea in Chronic Inflammatory Bowel Disease

Abstract

The importance of intestinal resection, exclusion of the colon, and steatorrhoea for secondary hyperoxaluria was studied in 81 patients with Crohn's disease and 12 patients with ileostomy after colectomy for ulcerative colitis during a metabolic regime including a fixed oral supply of fat, calcium, and oxalate. Hyperoxaluria (greater than 48 mg (greater than 0.5 mmol) per 24 h) was present in 21 patients with Crohn's disease. All but one half or more of the colon preserved. Renal oxalate excretion was related to the amount of ileum resected. 14C-oxalate absorption was significantly higher in patients with ileal resection and the whole colon preserved than in patients with ileal resection plus hemicolectomy, despite the fact that the latter group had the most extensive ileal resections. Faecal fat and oxalate excretion agreed well in patients without ileostomy (r = 0.76, p less than 0.001), and renal oxalate excretion was significantly higher in patients with steatorrhea and the colon preserved than in patients without steatorrhoea. In all 93 patients 14C-oxalate absorption and renal oxalate excretion was positively correlated with a coefficient of correlation of 0.76 (p less than 0.001). No correlation was present between 47Ca- and 14C-oxalate absorption. The study confirm that a preserved colon is necessary for secondary hyperoxaluria and stresses the importance of ileal resection and steatorrhoea.

Oxalate transport by anion exchange across rabbit ileal brush border.

“…Increased dietary oxalate absorption has been implicated in the etiology of calcium oxalate nephrolithiasis both in the presence and apparent absence of intestinal disease (1)(2)(3)(4)(5)(6). Until recently most investigators had concluded that oxalate was absorbed by a passive, noncarrier-mediated pathway and that increased absorption resulted from increased passive permeability and/or increased solubility of oxalate (2)(3)(4)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…Until recently most investigators had concluded that oxalate was absorbed by a passive, noncarrier-mediated pathway and that increased absorption resulted from increased passive permeability and/or increased solubility of oxalate (2)(3)(4)(7)(8)(9)(10)(11)(12)(13)(14). Hatch et al (15), SITS),' which suggests an anion exchange process on the brush border.…”

Characterization and Heterologous Expression of the Oxalyl Coenzyme A Decarboxylase Gene from Bifidobacterium lactis

“…In humans, an accumulation of oxalic acid can result in a number of pathological conditions, including hyperoxaluria, calcium oxalate nephrolithiasis, cardiomyopathy, and cardiac conductance disorders (24,39,51). In addition, several pathological conditions, including Crohn's disease, steatorrhea, and cystic fibrosis, or medical procedures such as jejunoilean bypass surgery are associated with enteric hyperoxaluria due to enhanced oxalic acid absorption in the colon (12,22,32). The importance of the colonic segment in regulating oxalic acid homeostasis has focused attention on the possible role oxalate-degrading colonic anaerobic bacteria may have in oxalate-related diseases.…”

Oxalate Nephropathy Associated with Chronic Pancreatitis

“…Oxalate precursors incriminated in toxic or drug-induced AON include acute poisoning by ethylene glycol (8) and ascorbic acid (21), respectively. Enteric hyperoxaluria has been described in various malabsorptive intestinal diseases, like jejuno-ileal bypass (17,22), short bowel syndrome (23,24), and chronic inflammatory bowel disease (25)(26)(27). Recently, short series have emphasized the risk of AON after modern bariatric surgery with Roux-en-Y gastric bypass (5,9).…”