Reduction of bile salt secretion in children with coeliac disease in activity and in remission.

To assess the role of intestinal absorption in bile secretion, the effects of milk perfusion into the duodenum on bile salt secretion were studied in children with active coeliac disease. Bile secretion was evaluated by measuring the bile salt concentration and output in the duodenum in response to a perfusion with a milk containing a casein hydrolysate as the protein source (4 ml/min/m2) followed by i.v. injection of 2 U/kg cholecystokinine (CCK). Bile salt output was estimated taking into account the dilution of the BSP perfused into the first part of the duodenum and collected 15 cm further on. Results found in nine children with active coeliac disease (A) were compared both to results for seven control children (C) and to those for three children with coeliac disease in remission (CDR). The values obtained show: 1. a significant drop in bile salt concentration and output in response to Nutramigen perfusion in groups A and CDR compared to group C; 2. a diminution in bile salt output perfusion is groups A and CDR; 3. smaller variations in bile salt output (expressed in mumol/min m2) after i.v. stimulation by CCK in group A (from 25 +/- 3.5 to 36 +/- 8.5) than in group C (from 46 +/- 6 to 52 +/- 9) or group CDR (from 19.5 +/- 1.4 to 52 +/- 20.6). However, there was no significant difference between the groups, because responses were heterogeneous; 4. there was no correlation between bile salt output or intestinal concentration of bile salt and fat absorption. These results indicate a reduction in bile salt secretion during the active phase of coeliac disease. The mechanism controlling this anomaly is not clear, since reduced bile salt output persisted after histological restoration of the duodenum.