Bile-Acid-Induced Intestinal Dysfunction: Implications to Protracted Infantile Diarrhea and Malnutrition

The pharmacologic effect of exogenous bile acids as cathartic agents is well known. Early formulations used as purgatives took advantage of the laxative effect of bile acids through administration of bile enemas or orally administered desiccated ox bile. Multiple studies have suggested that endogenous bile acids may also, in certain situations, induce diarrhea. The mechanism of the cathartic effect is better understood today; it appears that alterations in colonic motility as well as electrolyte and water transport are effected. In addition, it is known that bile acids are potent detergents and are capable of inducing membrane damage. In children with protracted diarrhea (with varying degrees of malnutrition), bile acids may serve to exacerbate or perpetuate the diarrhea and malabsorption and hence contribute to the vicious cycle (i.e., maintain a "sick bowel") and lead to continuing malnutrition.