Relationship between bile acid malabsorption and pancreatic insufficiency in cystic fibrosis.

Bile acid loss (mg/m2 24h) in the stools of 43 cystic fibrosis 
(CF) children with pancreatic insufficiency was 751-1 +/- 48-3, while that 
of six without clinical evidence of pancreatic disease (133-4 +/- 15- 
9) did not differ from values in 25 controls (109-8 +/- 
9-8). There was a good correlation between the degree of bile 
acid (BA) and fat sequestration. Concomitant changes in bile acid and 
fat loss were observed in the one group of six patients 
studied on and off pancreatic enzymes as well as in a 
second group of seven children treated with pancreatic supplements and maintained 
on a normal diet followed by a low fat diet supplemented 
with medium chain triglycerides. Administration of NA bicarbonate led to a 
significant decrease in fat loss (15-8 +/- 2-7 leads to 10-3 
+/- 1-9) without any simultaneous change in bile acid excretion (533-1 
+/- 58-3 leads to 500-4 +/- 58-6). Qualitative bile acid patterns 
in controls, in infants after an ileal resection, and in patients 
with CF or with coeliac disease showed that the percentage of 
primary BA followed closely the total amount excreted except in situations 
where antibiotics were administered. The exact mechanism for the increased loss 
of BA in CF is unknown. It is found in all 
age groups and is related to the presence and degree of 
pancreatic insufficiency. The possibility that unhydrolysed triglycerides may interfere with the 
intestinal absorption of bile acid needs further confirmation. 