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Gastroenterology Unit, Guy's Hospital Campus, Guy's, King's and St. Thomas' School of Medicine, Kings College, London, United Kingdom
Prolonged large bowel transit time
and an associated increase in the proportion of deoxycholic acid (DCA)
in serum and bile have been implicated in the development of
cholesterol-rich gallstones and colon cancer. Prolongation of
intestinal transit also increases intracolonic pH that, we
hypothesized, should favor the solubilization and absorption of newly
formed DCA within the colon. To test this hypothesis, we performed in
vitro studies on homogenized cecal aspirates (obtained at colonoscopy)
that were incubated anaerobically with [14C]cholic acid
for 16 h after which the pH was adjusted to between 4.0 and 7.0 in
0.5-pH unit steps. The resultant reaction mixtures were centrifuged to
separate the supernatant from the precipitate, and the specific
activity of [14C]DCA was quantitated in both phases. As
the pH in the aspirates was manipulated from 4.0 to 7.0, the proportion
of newly formed, labeled DCA increased in the supernatant and fell in
the precipitate, particularly at a hydrogen ion concentration
of <100 × 10
7 (equivalent to pH 5.0-7.0).
These results show that the solubility of DCA in colonic contents
increases with increasing pH. If solubility is rate limiting, this
should lead to increased absorption that, in turn, would explain why
the proportion of DCA in serum and bile increases with the prolongation
of large bowel transit time.
cholesterol gallstones; colorectal cancer; deoxycholic acid metabolism; bile acid solubility
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