Motonobu Hosomi

Home elemental enterai hyperalimentation (HEEH) for the maintenance of remission in patients with Crohn’s disease

SummarySince specific treatment has not yet been decided on for Crohn’s disease, the immediate target is the induction of remission and its maintenance. We examined the effects of an elemental diet (ED) in Crohn’s disease with special reference to the maintenance of remission. Eighty-four patients received total enterai nutrition with the ED (35 to 40 kcal/kg ideal body weight/day) and/or conventional drug treatment for induction of remission. Sixty-one patients in remission were then followed-up with prolonged ED therapy (home elemental enterai hyperalimentation, HEEH) and/or drugs. During the follow-up periods the course of patients receiving HEEH was better than those of patients without HEEH, namely the cumulative continuous remission rates after one, 2 and 4 years were, 94%, 63% and 63% in the group receiving HEEH, 75%, 66% and 66% in the group receiving HEEH and drugs, 63%, 42% and 0% in the group receiving drugs, and 50%, 33% and 0% in the group receiving no maintenance therapy, respectively. In particular, when more than 30 kcal/kg ideal body weight/day of the ED was given, the maintenance of remission was successful in 95% of the patients. These results indicated that ED therapy was effective not only for the induction of remission but also for the maintenance of remission in Crohn’s disease.

Fecal bile acid analysis in healthy Japanese subjects using a lipophilic anion exchanger, capillary column gas chromatography and mass spectrometry

SummaryDetailed fecal bile acid profiles of healthy Japanese subjects were studied using a lipophilic anion exchanger, capillary gas chromatography and mass spectrometry. Total daily excretion of bile acid into feces corrected for by fecal markers were between 127.99 to 366.33 μmole per day. Unconjugated bile acids constituted a major part, between 80 to 96%, of fecal bile acids. Glycine conjugated, taurine conjugated and sulfated bile acids were between 1 to 6, 0 to 3 and 1 to 10%, respectively. Esterified bile acids at C-24 position existed between 1 to 5%. Primary bile acids ranged from 0 to 55%. There were a number of epimers of hydroxy-and keto-bile acids, and lithocholic and deoxycholic acid were major secondary bile acids among them. A cholenoic acid was detected in the unconjugated fraction of one subject. It seems necessary to analyze the details not only on the type of bile acids but also on the mode of conjugation in biological samples. Thus, the methodology described in this study has made it easier to investigate on the role of bile acid in the physiology or pathophysiology of the gastrointestinal tract.

The role of intestinal bacteria in gallstone formation in animal model. A study on biliary lipid composition and bile acid profiles in bile, small intestinal contents and feces of Clostridium butyricum MIYAIRI No. 588 monocontaminated mice

SummaryContradictory results in the studies on experimental gallstone formation using conventional and germfree mice have been reported. To study the role of bacteria in gallstone formation in the animal model JCL:ICR male germfree mice were monocontaminated with Clostridium butyricumMIYAIRI No. 588. Gallstone formation, biliary lipid composition and bile acid profiles in the bile, small intestinal contents and feces were analyzed after feeding the diet containing cholesterol and cholic acid. The rate of gallstone formation in the monocontaminated mice (38%) was less than that in the germfree mice (100%). The relative concentrations of biliary lipids of the two groups were located out of the micellar zone on the triangular co-ordinates by Admirand and Small. The bile acid concentrations in the small intestine and fecal excretions in the monocontaminated mice were higher than in the germfree mice. The composition as well as the mode of conjugation of the bile acids did not differ significantly between the two groups. The infestation of bacteria in the intestine enhanced the excretion of bile acids and inhibited the gallstone formation in mice, in which direct metabolic activity by bacterial enzymes on bile acid did not seem necessary to exert such effect.

Abstracts of selected papers presented at the 73rd general meeting of the Japanese Society of Gastroenterology Tokyo, Japan, April 7–9, 1987

S OF SELECTED PAPERS PRESENTED AT THE 73RD GENERAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY Tokyo, Japan, April 7-9, 1987 Chairman : Shinroku ASHIZAWA, M. D.