Absorption of bile acids after ileoanal anastomosis

Absorption of bile acids was investigated using 75Se-homotaurocholate (SeHCAT) in 27 patients with ileoanal anastomosis and J-pouch, 7 patients with conventional ileostomy and 9 non-operated patients with ulcerative colitis. Retention of SeHCAT at seven days was higher in non-operated patients than in patients with ileoanal anastomosis (P less than 0.001) or conventional ileostomy (P less 0.01). There was no difference in retention of SeHCAT between patients with ileoanal anastomosis or conventional ileostomy. Malabsorption of bile acids was not associated with changes in blood chemistry or faecal fat excretion. Patients with ileoanal anastomosis and low retention of SeHCAT had more severe villous atrophy of the pouch mucosa than those with high retention (P less than 0.05). In conclusion, both patients with ileoanal anastomosis and conventional ileostomy have impaired absorption of bile acids when compared with non-operated patients with ulcerative colitis. In patients with ileoanal anastomosis, impairment of bile acid absorption is related to villous atrophy of the pouch mucosa.