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[Why do children rarely have gallstones? Examinations of the lithoindices and the bile acid pattern in infants and children in health and disease (author's transl)].

Cholesterol gallstones occur 600-1000 times more frequent in adults than in children. Seeking a possibility to explain this discrepancy, the molar concentrations of cholesterol, lecithin and bile acids as well as the bile acid pattern have been determined in duodenal juice, after an injection of 2 U/kg pancreocymin, of 33 children aged between 4 months and 14 years who were gastroenterologically healthy. The absolute values as well as the percentage composition were calculated. The lithoindices have been determined to be Li1=0.54 +/- 0.25 and Li2=1.06 +/- 0.50 according to the formulas of Thomas and Hofmann. Dependence on age in infancy and during childhood could be excluded. The main reason for the fact that hardly any gallstones occur among children, compared to the occurrence in adults seems to be the small concentration of cholesterol in the bile. Whereas there had been no deviations either of lithoindices or in the bile acid pattern in 10 patients with coeliac disease, 2 out of 6 children with mucoviscidosis and 3 out of 4 children with small bowel syndrome showed apparently increased lithoindices. Only in the last group a bile acid pattern was found which could reduce the higher risk of getting cholelithiasis.

Adolescent↗

Effect of intravenous somatostatin on stool output in diarrhea due to Vibrio cholerae.

Somatostatin has been shown to inhibit intestinal secretion induced by a variety of secretagogues. The ability of somatostatin to reduce stool output in patients with cholera was therefore investigated in a double-blind randomized controlled trial. Twenty-two patients with severe purging due to infection with Vibrio cholerae (less than or equal to 12.5 ml/kg X h) received either somatostatin at a dose of 250 micrograms/h in saline (n = 12) or placebo (n = 10). The study drug was given for 12 h followed by a control period of the same duration. No difference in stool output was apparent between somatostatin- and placebo-treated groups. No side effects of somatostatin were observed. It is concluded that somatostatin is ineffective as an antidiarrheal agent in Asiatic cholera in humans.

Adult↗

Fiber, steroids, and cancer.

Fiber is a generic term for dietary components which are not metabolized by intestinal secretions. Fiber encompasses a variety of substances of unique structure having specific physical characteristics and physiological function. There are a number of epidemiological and case-control studies on diet and colon cancer, many of which suggest that dietary fiber or fiber-rich foods may exert a protective action, but the view is not unanimous. One study finds a negative correlation between cancer mortality and pentose-rich dietary fibers. Animal studies have been carried out using rats of different strain, semipurified or commercial diets, and various carcinogens administered in a variety of ways. Again, there is no unanimity. The results depend upon the type of fiber and the route of carcinogen administration. Some type of fiber bind bile acids and salts, and this property has been investigated as a means of explaining the protective action of fiber. Several recent studies in human subjects suggest that susceptibility to colon cancer is related inversely to the concentration of fecal bile acids rather than to the absolute quantity of fecal bile acids or their structure. Future studies require better standardization of protocols so that intradietary effects can be assessed.

Animals↗

Treatment of chronic secretory diarrhea of unknown origin by lithium carbonate.

A 49-yr-old patient developed severe chronic secretory diarrhea associated with hypokalemia and gastric hypochlorhydria. Small bowel perfusion study revealed active proximal intestinal secretion. Despite thorough investigation, the cause of her secretory diarrhea was not elucidated. Her diarrhea was refractory to indomethacin, prednisone, and trifluoperazine therapy. The life-threatening profuse watery diarrhea responded, however, to oral lithium carbonate, an agent reported to inhibit cyclic adenosine monophosphate synthesis. Diarrhea stopped within 4 days of initiation of lithium chloride therapy. Discontinuation of lithium 2 wk later resulted in return of watery diarrhea. Lithium therapy was reinstituted and her diarrheal symptoms resolved completely. Three months later, lithium carbonate was discontinued. The patient continued to be well and remained asymptomatic 15 mo after discontinuation of therapy. Therefore, in patients with chronic secretory diarrhea in whom exhaustive tests fail to reveal an etiology, a trial of oral lithium therapy may be beneficial in ameliorating the disabling symptoms and could be life-saving.

Biological Transport↗

Bacterial overgrowth associated with a naturally occurring enteropathy in the German shepherd dog.

Quantitative and qualitative bacteriological studies were performed on duodenal juice from 19 dogs with chronic small intestinal disease. Bacterial overgrowth was demonstrated in seven German shepherd dogs with minimal histological but specific biochemical abnormalities in the jejunal mucosa. Most frequently this overgrowth comprised bacteria of the normal flora, particularly Escherichia coli and enterococci, but these were occasionally accompanied by bacteria rarely present in the proximal small intestine of the normal dog, particularly Clostridium species. In most cases this overgrowth was associated with raised serum folate and reduced serum vitamin B12 concentrations, a finding consistent with the capacity of many enteric bacteria to synthesise folate and bind vitamin B12.

Animals↗