Ileal resection: effect of cimetidine and taurine on intrajejunal bile acid precipitation and lipid solubilisation.

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Abstract
We have investigated whether pH-dependent bile acid precipitation limits lipid solubilization after ileal resection, and whether treatment with cimetidine, or taurine improves solubilization. Nine ileal resection patients were treated with placebo, cimetidine and taurine in random order for two weeks each. Upper jejunal content was aspirated and pooled according to pH for three hours after a standard Lundh test meal. On placebo, 50% of the bile acids were precipitated at pH < 5, compared with only 26% at pH > 6, whilst aqueous-phase lipid concentration tended to be lower at pH < 5 than at pH > 6 (5.1 vs 8.2 mmol/l). On cimetidine mean pH rose, particularly during the third hour (6.6 vs 5.8, P < 0.05), associated with a reduction in bile acid precipitation (13.9 vs. 33.1%, P < 0.05), and an increase in aqueous-phase lipid concentration (10.4 vs 6.6 mmol/l, P < 0.05). On taurine, the proportion of taurine conjugated bile acids increased (67 vs. 22%, P < 0.01), but there was no significant change in bile acid precipitation or lipid solubilization. Lower jejunal samples were aspirated similarly from five of these patients on no treatment, and all were at pH > 6; apparent ''precipitation'' was reduced (16.4 vs 28.1%), but lipid solubilization did not improve. These findings suggest that pH dependent bile acid precipitation can limit lipid solubilization within the jejunum after ileal resection, and that these effects can be reduced by cimetidine but not by taurine. Cimetidine may have a role in ileal resection patients with severe steatorrhoea unresponsive to dietary fat restriction.