Decreased trypsin and bile acids in ileal fistula drainage during the administration of a chemically defined liquid elemental diet

Abstract

Ten patients with a well-established ileostomy were studied in a metabolic ward and alterations in ileostomy content of trypsin and bile acids were measured during the ingestion of an elemental diet. After a 4-day control study the patients were given an elemental diet as the sole nutritional source for a 10-day period. For the last 3 days of the study an additional 2 litres of water were consumed with the elemental diet. The mean daily faecal output for the group during the control period was 578 ± 300 ml, and during administration of the elemental diet the fistula output fell to 418 ± 90 ml (P<0·02) and there was a fall in the concentration of sodium in the ileal fluid (104·7 ± 22 mEq/l to 80·2 ± 25 mEq/l, P < 0·01). For the group as a whole there was a fall in the concentration of trypsin (0·671 ± 0·53 i.u./ml to 0·554 ± 0·56 i.u/ml, P< 0·025) and bile acids (0·911 ± 0·56 mmol/ml to 0662 ± 0·53 mmol/ml, P < 0·005) in the ileal excreta. Although the concentration of amylase in the ileal fluid rose, the total output was not altered. Oral administration of an additional 2 litres of water did not alter the concentration of trypsin or bile acids in the ileal fluid. It is concluded that elemental diet ingestion produces changes in ileal fistula output which are of benefit to the patient with an enterocutaneous fistula. Output from the fistula of fluid and electrolyte is less and the corrosive nature of the discharge is reduced.