Minimal bile acid malabsorption [letter].

Roller and Kern report that bile acid malabsorption in patients with cystic 
fibrosis (CF) and acquired pancreatic insufficiency is minimal. These findings are 
at variance with other studies and deserve comment. In the absence 
of fecal bile acid values in controls, the authors cannot state 
that levels in CF are only twice normal values, especially since 
the papers cited on normal bile acid excretion refer to measurements 
obtained by a different technique. We also question the validity of 
the breath test as an index of bile acid malabsorption in 
CF. Our recent report shows that in 8 older CF (mean 
age 12.1 years) the magnitude of bile acid loss in the 
stools was comparable to that of the younger age group (mean 
age 3.9 years) and that there was no correlation between the 
age and the degree of bile acid loss. On the other 
hand, we must take issue with Roller and Kern when they 
suggest that bile acid malabsorption in CF is probably not clinically 
important. Our findings not only bear relevance to the intestinal manifestations 
of CF and to the increased incidence of cholelithiasis but perhaps 
also to the early deposition within the intrahepatic ducts of eosinophilic 
mucus concretions proposed as the cause of biliary cirrhosis in this 
disease. 