Ileal bile acid malabsorption in colonic Crohn's disease
- Thread starter kiny
- Start date
Help Support Crohn's Disease Forum:
kiny
Well-known member
- Joined
- Apr 28, 2011
- Messages
- 3,464
I had a few posts about bile acids, but not that many. Anyway, it's rather interesting in relation to crohn's disease. The body uses bile to help absorb dietary fats and fat soluble vitamins. It's produced by the liver and enzymes where cholesterol turns into cholic acid and chenodeoxycholic acid (combined with glycine and taurine). They get stored in the gallbladder until you consume fats, the gallbladder will contract and release them into the intestine at the duodenum.
The part that interests us is when that bile enters the ileum, where most of it is reabsorbed by intestinal epithelial cells. It gets sent back up to the liver through the hepatic portal vein. This process is called "enterohepatic circulation".
What's interesting is that bacteria in the ileum use these primary bile acids, they chemically alter them and turn them into secondary bile acids, deoxycholic acid and lithocholic acid. They use for their own growth and to create a hostile environment for competing, often pathogenic bacteria.
As I said above, enterohepatic circulation describes the recycling of this bile acid after ileal aborption, so you can end up measuring it in blood. You can use it to test liver function, etc.
But what we're interested in is how this relates to crohn's disease. You can measure for specific bile acids. Primay BA (bile acids) aren't different from HC, but secondary BA of crohn's disease are.
The reason it's interesting is because these BA have an effect on immune cells, and diet influences these BA concentration. I'm interested in it also simply because diet greatly influences these measurable secondary BA concentrations, and since EN works so well for crohn's, which has a rather specific MCT fat profile to aid absorption. It is also interesting because these secondary BA are a window of what is going on with potential pathogens and commensals in the intestine.
The part that interests us is when that bile enters the ileum, where most of it is reabsorbed by intestinal epithelial cells. It gets sent back up to the liver through the hepatic portal vein. This process is called "enterohepatic circulation".
What's interesting is that bacteria in the ileum use these primary bile acids, they chemically alter them and turn them into secondary bile acids, deoxycholic acid and lithocholic acid. They use for their own growth and to create a hostile environment for competing, often pathogenic bacteria.
As I said above, enterohepatic circulation describes the recycling of this bile acid after ileal aborption, so you can end up measuring it in blood. You can use it to test liver function, etc.
But what we're interested in is how this relates to crohn's disease. You can measure for specific bile acids. Primay BA (bile acids) aren't different from HC, but secondary BA of crohn's disease are.
The reason it's interesting is because these BA have an effect on immune cells, and diet influences these BA concentration. I'm interested in it also simply because diet greatly influences these measurable secondary BA concentrations, and since EN works so well for crohn's, which has a rather specific MCT fat profile to aid absorption. It is also interesting because these secondary BA are a window of what is going on with potential pathogens and commensals in the intestine.
Last edited:
Anna's Bandit
Member
Anything newer than 1994 written up about this ?
kiny
Well-known member
- Joined
- Apr 28, 2011
- Messages
- 3,464
I need to read what effects EN has on secondary BA and if BA sequestrants were ever used in CD patients, I'm sure BA sequestrants are individually prescribed in patients for bile acid diarrhea, who happen to have CD. It's probably just less likely in CD patients, due to risks of interferring with nutrient uptake. When patients with CD are underweight, and complain of diarrhea, you don't want to make nutrient uptake worse.
Last edited:
Perhaps this can explain why EEN is effective. When we are in EEN, our intestines are clean, and the increase of bile acids will restrain or kill AIEC。By combine EEN with antibiotics，we can create a more favorable environment that AIEC will be more effectively eliminated.
Similar threads
