Bile Salt, Fat, Water, and Vitamin B12Excretion after Ileostomy

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Abstract
Increased bile salt loss was a rare phenomenon in patients subjected to total colectomy and ileostomy for ulcerative colitis, provided the remaining terminal ileum was intact. Ileostomy discharge was increased by enhanced bile salt output. Apart from deconjugation of bile salts, bacterial action on ileostomal acidic and neutral steroids was negligible or absent. Fat content of dejecta was frequently elevated and correlated with vitamin B12 absorption but not with neutral sterol or bile salt elimination. Absence of a bile salt deficiency was indicated by a normal jejunal bile salt concentration and normal micellar phase lipids during fat absorption; the oil phase was expanded, however. Serum cholesterol was normal and serum methyl sterols correlated with sterol balance data, indicating that augmented loss of cholesterol as bile acids was balanced sufficiently by increased cholesterol synthesis.