Enteric Hyperoxaluria: Dependence on Small Intestinal Resection, Colectomy, and Steatorrhoea in Chronic Inflammatory Bowel Disease

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Abstract
The importance of intestinal resection, exclusion of the colon, and steatorrhoea for secondary hyperoxaluria was studied in 81 patients with Crohn's disease and 12 patients with ileostomy after colectomy for ulcerative colitis during a metabolic regime including a fixed oral supply of fat, calcium, and oxalate. Hyperoxaluria (>48 mg (> 0.5 mmol) per 24 h) was present in 21 patients with Crohn's disease. All but one had half or more of the colon preserved. Renal oxalate excretion was related to the amount of ileum resected. 14C-oxalate absorption was significantly higher in patients with ileal resection and the whole colon preserved than in patients with ileal resection + hemicolectomy, despite the fact that the latter group had the most extensive ileal resections. Faecal fat and oxalate excretion agreed well in patients without ileostomy (r = 0.76, p < 0.001), and renal oxalate excretion was significantly higher in patients with steatorrhoea and the colon preserved than in patients without steatorrhoea. In all 93 patients 14C-oxalate absorption and renal oxalate excretion was positively correlated with a coefficient of correlation of 0.76 (p < 0.001). No correlation was present between 47Ca- and 14C-oxalate absorption. The study confirms that a preserved colon is necessary for secondary hyperoxaluria and stresses the importance of ileal resection and steatorrhoea.