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Intestinal absorption of ursodeoxycholic acid in children and adolescents with inflammatory bowel disease
T Fujisawa1, A Kimura, K Ushijima
1Department of Pediatrics and Child Health, Kurume University, School of Medicine, Asahimachi, Japan.
Insights
Ursodeoxycholic acid absorption is impaired in pediatric Crohn's disease patients, particularly during active stages. The oral ursodeoxycholic acid tolerance test effectively evaluates bile acid absorption in pediatric patients with Crohn's disease.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Bile Acid Metabolism
Background:
- Proximal intestinal absorption of ursodeoxycholic acid (UDCA) may be compromised in inflammatory bowel disease (IBD).
- Assessing UDCA absorption is crucial for understanding bile acid homeostasis in pediatric IBD patients.
Purpose of the Study:
- To investigate UDCA intestinal absorption in children and adolescents with IBD using an oral UDCA tolerance test.
- To evaluate the utility of the oral UDCA tolerance test in pediatric IBD.
Main Methods:
- Oral UDCA tolerance test administered to 19 pediatric patients with IBD (Crohn's disease and ulcerative colitis) and 8 healthy controls.
- IBD patient groups included unoperated Crohn's disease, ileal-resected Crohn's disease, and ulcerative colitis at various disease stages.
Main Results:
- Significant UDCA malabsorption observed in active-stage unoperated Crohn's disease patients compared to controls (p < 0.01).
- Abnormal UDCA absorption noted in the early postoperative period for ileal-resected Crohn's disease, normalizing over time.
- No UDCA malabsorption detected in ulcerative colitis patients.
Conclusions:
- Proximal intestinal UDCA absorption is impaired in pediatric Crohn's disease, especially during active phases.
- The oral UDCA tolerance test is a practical tool for assessing proximal intestinal bile acid absorption in pediatric Crohn's disease.
Background:
Ursodeoxycholic acid absorption in the proximal intestine may be impaired in patients with inflammatory bowel disease.
Methods:
We examined the intestinal absorption of ursodeoxycholic acid by the oral ursodeoxycholic acid tolerance test in 19 children and adolescents with inflammatory bowel disease at various stages, including 8 patients with unoperated Crohn's disease, 3 patients with ileal-resected Crohn's disease, 8 with ulcerative colitis, and 8 healthy control subjects.
Results:
Ursodeoxycholic acid malabsorption was present in all patients with unoperated Crohn's disease in the first diagnosed active stage, in 3 of 5 patients in a relapsing active stage, and in 2 of 8 patients in remission. Ursodeoxycholic acid absorption was significantly lower in patients in the first diagnosed active stage than in the healthy controls (p < 0.01) or in patients in remission (p < 0.01). There was no significant difference between healthy controls and the patients in a relapsing active stage or in remission. Ursodeoxycholic acid absorption was abnormal during the first postoperative month in patients with ileal-resected Crohn's disease, but normalized over time. Malabsorption of ursodeoxycholic acid was not observed in any patients with ulcerative colitis.
Conclusions:
These findings suggest that absorption of ursodeoxycholic acid in the proximal intestine is impaired in patients with Crohn's disease and that the oral ursodeoxycholic acid tolerance test is a convenient and useful means of evaluating the absorption of bile acid in the proximal intestine in pediatric patients with ileal or ileocolic Crohn's disease.