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Bile acid excretion after pull-through operation for Hirschsprung's disease
Insights
Children with chronic diarrhea after Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Bile Acid Metabolism
Background:
- Hirschsprung's disease is a congenital condition affecting the large intestine.
- Pull-through operations are a common surgical treatment for Hirschsprung's disease.
- Chronic diarrhea and perianal excoriation can be complications post-surgery.
Purpose of the Study:
- To investigate potential causes of chronic diarrhea and perianal excoriation after pull-through surgery for Hirschsprung's disease.
- To analyze bile acid levels and metabolism in affected pediatric patients.
Main Methods:
- Faecal bile acid levels were measured in four children.
- Duodenal fluid was collected after pancreozymin stimulation in three patients.
- Bile acid composition, specifically deoxycholic acid conjugates, was analyzed.
Main Results:
- Patients exhibited increased, though not markedly raised, faecal bile acid levels.
- A significant reduction in deoxycholic acid conjugates was observed in duodenal fluid.
- Findings suggest colonic malabsorption of secondary bile acids.
Conclusions:
- Colonic malabsorption of secondary bile acids is present in these patients.
- This malabsorption is linked to the pull-through operation for Hirschsprung's disease.
- The malabsorption is unlikely to be the primary cause of the observed diarrhea and anal excoriation.
Abstract:
Four children with chronic diarrhoea and perianal excoriation after a pull-through operation for Hirschsprung's disease have been shown to have increased but not markedly raised levels of faecal bile acids. Bile acid analysis of the 'bile-rich' duodenal fluid obtained after pancreozymin stimulation in 3 of the patients indicated a marked reduction in the proportion of deoxycholic acid conjugates. These findings are compatible with colonic malabsorption of secondary bile acids in these patients which is related in some way to the pull-through operation, but which is not likely to be the cause of the diarrhoea and the anal excoriation.