Taruishi M, Ashida T, Shibata Y
Third Department of Internal Medicine, Asahikawa Medical College, Japan.
Hokkaido Igaku Zasshi. 1994 May;69(3):574-83, 585.
Oral bile acid tolerance test has been used to detect a functional impairment of the small intestine in Crohn's disease. The damage should be strongly expressed in the terminal ileum because of preferential involvement, therefore, we devised the retrograde ileal bile acid tolerance test, where bile acid was administered into closed segment of the terminal ileum using a 4 lumen double balloon tube through a colonoscope. In basic experiment using dogs with or without experimentally induced ileitis by trinitrobenzene sulfonic acid, ursodeoxycholic acid (UDCA) solution of several concentrations was given into the duodenum (corresponding to oral test) or the terminal ileum. Plasma was collected for 60 min at given time points, and then plasma total bile acid level (TBA) and bile acid fraction were measured. In a clinical study, both oral test and retrograde ileal bile acid tolerance test were carried out in 5 cases of Crohn's disease with ileitis and 6 healthy control subjects. Plasma was collected for 30 min after ileal loading of 30 ml UDCA solution (10 mg/ml). In oral bile acid tolerance test, plasma was collected for 180 min after taking 600 mg of UDCA. Basic experiments in dogs showed: 1) TBA was increased in proportion to dose of UDCA loaded in the intact ileum. 2) Absorption of bile acid after ileal loading of UDCA was significantly suppressed in experimentally induced ileitis, whereas no difference was observed after duodenal loading of UDCA. Clinical study in human subjects showed; 1) Absorption of bile acid after ileal loading of UDCA was significantly suppressed in Crohn's disease, compared with controls. 2) Examination of bile acid fraction showed that more than 90% of bile acid increased in serum after ileal loading of UDCA was free type UDCA. These findings indicated that retrograde ileal bile acid tolerance test is useful for an accurate evaluation on absorptive function in the ileum.
口服胆汁酸耐量试验已被用于检测克罗恩病患者小肠的功能损害。由于病变多累及回肠末端，因此损害在该处应表现得较为明显。为此，我们设计了逆行回肠胆汁酸耐量试验，通过结肠镜用四腔双气囊导管将胆汁酸注入回肠末端的封闭段。在基础实验中，对经三硝基苯磺酸诱导或未诱导回肠炎的犬，分别将几种浓度的熊去氧胆酸（UDCA）溶液注入十二指肠（相当于口服试验）或回肠末端。在给定时间点采集血浆60分钟，然后测定血浆总胆汁酸水平（TBA）和胆汁酸组分。在一项临床研究中，对5例患有回肠炎的克罗恩病患者和6名健康对照者进行了口服试验和逆行回肠胆汁酸耐量试验。在回肠注入30 ml UDCA溶液（10 mg/ml）后采集血浆30分钟。在口服胆汁酸耐量试验中，服用600 mg UDCA后采集血浆180分钟。犬的基础实验显示：1）在完整回肠中，TBA随UDCA注入剂量的增加而升高。2）实验性诱导回肠炎时，回肠注入UDCA后胆汁酸的吸收显著受抑制，而十二指肠注入UDCA后未观察到差异。人体临床研究显示：1）与对照组相比，克罗恩病患者回肠注入UDCA后胆汁酸的吸收显著受抑制。2）胆汁酸组分检查显示，回肠注入UDCA后血清中增加的胆汁酸90%以上为游离型UDCA。这些结果表明，逆行回肠胆汁酸耐量试验有助于准确评估回肠的吸收功能。
