American Journal of Clinical Nutrition, Vol 23, 1569-1578, Copyright © 1970 by The American Society for Clinical Nutrition, Inc.

Tropical Sprue and Malnutrition in West Bengal

III. Biochemical Characterisitics of Bile Salts in the Small Intestine

¹ From the Biochemistry Research Division, Department of Medicine, Sinai Hospital of Baltimore and the Johns Hopkins University Center for Medical Research and Training, Calcutta, India

The bile salt composition of small bowel aspirates from three patients with tropical sprue and one with protein-calorie malnutrition was compared with those from two control Bengali subjects. Serial studies were performed on the patients on admission, during treatment and at recovery from the disease. A decreased glycine-taurine ratio of cholate from duodenojejunal samples of patients with tropical sprue is suggestive of a partial failure of the liver to conjugate bile acids with glycine, in contrast to the elevated G-T ratio in protein-calorie malnutrition. In two of the tropical sprue subjects and in one of the controls, glycochenodeoxycholate was rarely detected, although the corresponding taurine conjugate was present in significant amounts. Treatment and subsequent recovery from tropical sprue did not alter this condition, indicating the existence of adaptive mechanisms in the liver that contribute specificity towards both the bile acid and amino acid components of the bile salt conjugating system. The presence of significant amounts of conjugated lithocholate in aspirates from tropical sprue in the pre- and posttreatment phases of the disease and in the control subjects appears to reflect active colonization of the intestinal tract by organisms possessing both deconjugating and dehydroxylating functions.