Detection of Bacterial Deconjugation of Bile Salts by a Convenient Breath-Analysis Technic

Abstract

When glycine-1–¹⁴C-cholate was given orally and ¹⁴CO₂ specific activity of expired air measured by a breath-analysis technic, the results clearly separated patients with either ileal resection or bacterial-overgrowth syndromes from subjects without abnormalities of bile-salt metabolism. The normal subjects and the patients with steatorrhea unrelated to abnormalities of bile-salt metabolism had no appreciable rise in ¹⁴CO₂ excretion (2.2 ± 0.60 [S.E.] and 1.3 ± 0.31 per cent administered dose, respectively) whereas subjects with ileal resection and bacterial-overgrowth syndromes had a rapid appearance of ¹⁴CO₂ in expired breath (31.4 ± 4.62 and 23.4 ± 6.78 per cent of administered dose, respectively). Elimination of bacterial overgrowth with antibiotics or surgical fistula repair returned ¹⁴CO₂ excretion (0.7 ± 0.23 per cent) to normal. Thus, the breath test will detect increased bacterial deconjugation of bile salts and assess effective antibiotic management of bacterial-overgrowth syndromes.