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Bile acids, diarrhea, and antibiotics: data, speculation, and a unifying hypothesis
The Journal of Infectious Diseases
|March 1, 1977
Summary
High concentrations of bile acids, like chenodeoxycholic acid, in the colon increase intestinal permeability and fluid secretion, potentially causing diarrhea. This highlights their role in conditions like clindamycin-induced colitis.
Area of Science:
- Gastroenterology
- Physiology
- Microbiology
Background:
- Primary bile acids (chenodeoxycholic acid) and secondary bile acids (deoxycholic acid) influence colonic function.
- In healthy individuals, bile acids are metabolized and precipitated in the colon.
- Bile acid malabsorption leads to elevated colonic bile acid concentrations.
Purpose of the Study:
- To investigate the effects of bile acids on colonic permeability and secretion.
- To explore the role of elevated bile acids in diarrhea and colitis.
Main Methods:
- Concentration-dependent studies of bile acids on colonic salt and water secretion.
- Assessment of colonic permeability to molecules (200-500 daltons).
- Scanning electron microscopy to evaluate tissue integrity.
- Clinical observation of bile acid diarrhea and response to cholestyramine.
Main Results:
- Bile acids above 3 mM induce salt and water secretion and increase colonic permeability.
- Tissue damage observed in some species.
- Reduced dehydroxylation in bile acid diarrhea leads to elevated colonic bile acid levels.
- Cholestyramine effectively reduces bile acid concentration and resolves diarrhea.
Conclusions:
- Elevated primary bile acid concentrations in the colon contribute to diarrhea.
- This mechanism may explain diarrhea and pseudomembranous colitis associated with clindamycin use.