Table 1 Clinical findings of diabetics. hypoglycemic agent

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2 Table 1 Clinical findings of diabetics 1)oral hypoglycemic agent

3 Fig. 3 The ratio of primary bile acid to total bile acid Fig. 1 Fecal wet weight Fig. 4 Fecal fatty acid Fig. 2 Fecal bile acid excretion

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5 Roentgenologic study of the small intestine, 11. Dysfunction associated with neurologic diseases, Radiology, 49: (1947) 18) Scarpello, J. H. B., Greaves, M., Sladen, G. E.: Small intestinal transit in diabetics, Brit. Med. J., 2: (1976) 19) McNally, W.F., Reinhard, A. E., Schwartz, P.E.: Small bowel motility in diabetics, Am. bladder, Diabetes, 12: (1963) 7) Molloy, A. M., Tomkin, G. H.: Altered bile in diabetic diarrhea, Brit. med. J., 25: (1978) 23) Bennion, L. J., Grundy, S. M.: Effects of dia- betes mellitus on cholesteol metabolism in man, N. Engl. J. Med., 296: ) Grundy, S. M., Ahrens, E. H., Miettinen, T. A.: Quantitative isolation and gas-liquid chromatographic analysis of total fecal bile acids, J. Lipid Res., 6: (1965) 25) Clarke, B. F., Ewing, D. J., Campbell, I. W., Diabetic autonomic neuropathy, Diabetologia, 17: (1979) 26) Condon, J. R., Robinson, V., Suleman, M. I., Fan, V. S.: The cause and treatment of postvagotomy diarrhea, Brit. J. Surg., 62: 11) Dowling, R. H.: The enterohepatic circulation, 309- Gastroenterology, 62: (1972) 12) Hofmann, A. F.: Consequences of bile acid malabsorption, Mayo Clin. Proc., 48: (1973) 13) Small, D. M., Dowling, R. H., Redinger, R. N.: The enterohepatic circulation of bile salts, Arch. Intern. Med., 130: (1972) 14) Rundles, R. W.: Diabetic neuropathy-general review with report of 125 cases, Medicine, 24: (1945) 15) scarpello, J. H. B., Hague, R. V., Cullen, D. R., Sladen, G. E.: The 14c-glycocholate test in diabetic diarrhea, Brit. Med. J., 2: , (1976) 16) Feldman, M., Corbett, D. B., Ramsey, E. J., Walsh, J. H., Richardson, C. T.: Abnormal gastric function in longstanding, insulin-dependent diabetic patients, Gastroenterology, 77: (1979) 17) Hodges, F. J., Rundles, R. W., Hanelin, J.: J. Dig. Dis., 14: (1969) 20) Gitelson, S., Schwartz, A. Fraenkel, M., Chowers, I.: Gall-bladder dysfunction in diabetes mellitus, The diabetic neurogenic gall 22) Low-Beer, T. S., Heaton, K. W., Pomare, E. W., Read, A. W.: The effect of coeliac disease upon bile salts, Gut, 14: (1973) (1977) 24) Saudek, C. D., Brach, E. L.: Cholesterol metabolism in diabetes, 27: (1978) 312 (1975) 27) Mekhjiian, H. S., Phillips, S. F., Hofmann, A. F.: Colonic secretion of water and electrolytes induced bile acids: Perfusion studies in man, J Clin. Invest., 50: (1971) 28) Galapeux, E. A., Templeton, R. D., Borkon, E. L.: The influence of bile on the motility of the dog's colon, Amer. J. Physiol., 121: (1938) 29) Green, P.A., Berge, K. G., Sprague, R. G.: Control of diabetic diarrhea with antibiotic therpy, Diabetes, 17: (1968) 30) Snoog, C. S., Thomson, J. B., Poley, J. R., Hess, O. R.: Hydroxy fatty acids in human diarrhea, Gastroenterology, 63: (1972) 31) Duncombe, V. M., Bolin, T. D., Davis, A. E.: Double-blind trial of cholestyramine in postvagotomy diarrhea, Gut, 18: (1977) 32) Condon, J. R., Suleman, M. I., Fan, Y. S.,

6 McKeown, M. D.: Cholestyramine and diabetic and post-vagotomy diarrhea, Brit. Med. J., 17: 423 (1973) 33) Malins, J. M., Mayne, N.: Diabetic diarrhea- A study of thirteen patients with jejunal biopsy, Diabetes, 18: (1969) 34) Malins, J. M., French, J. M.: Diabetic diarrhea, Quart. J. Med., 26: (1957) 35) Mitchell, W. D., Findlay, J. M., Prescott, R. J., Eastwood, M. A., Horn, D. B.: Bile acids in the diarrhea of ileal resection, Gut, 14: (1973) 36) Woodbury, J. F., Kern, F. Jr.: Fecal excretion of bile acids: A new technique for studying bile acid kinetics in patients with ileal resection, J. Clin. Invest., 50: (1971) 37) Go. V. L. W., Poley, J. R., Hofmann, A. F., Summerskill, W. H. J.: Disturbances in fat digestion induced by acidic jejunal ph due to gastric hypersecretion in man, Gastroenterology, 58: (1970) 38) Roller, R. J., Kern, F. Jr.: Minimal bile acid malabsorption and normal bile acid breath tests in cystic fibrosis and acquired pancreatic insufficiency, Gastroenterology, 72: (1977) 39) Weber, A. M., Roy, C. C., Morin, C. L., Lasalle, R.: Malabsorption of bile acids in children with cystic fibrosis, N. Engl. J. Med., 289: (1973)

7 Abstract Abnormalities of Bile Acid Metabolism in Diabetics(1) Fecal Bile Acid Excretion \ Teruo Nakamura,Ken-ichi Imamura,Tadashi Miyazawa, Koji Machida,Isao Makino,and Kazuo Takebe The Third Department of Internal Medicine,Hirosaki University,Japan The present study was undertaken to determine the amount of fecal bile acid excretion in 26 diabetic subjects.the subjects were divided into3groups according to the presence of diabetic neuropathy.group I included13cases without neuropathy,group II included11cases with diabetic neuropathy,and Group III included cases with diabetic diarrhea.fecal bile acid and fecal fatty acid were determined by gas-liquid chromatography.the following results were obtained. 1)The fecal wet weight per day was141.8g in controls,185.0g in Group I,238.5g in Group II,and280and700g in Group III.There was no significant difference among the groups. 2)The fecal bile acid excretion per day was4.56mg/kg in controls,6.89mg/kg in Group I,15.0mg/kg in Group II,and15.2and24.7mg/kg in Group III.The fecal bile acid output was significantly increased in Group II compared to the controls and Group I. 3)The ratio of primary bile acid to total bile acid was14% in controls,13.7% in Group I, and27.6% in Group II.The ratio was markedly increased in the2cases of Group III with diabetic diarrhea(40.8%and76.5%). 4)Increased fecal fatty acid excretion(steatorrhea)was present in only one case of Group I and Group II,and the increase was to a slight degree. The above reslts suggest that fecal bile acid excretion was increased in diabetics with neuropathy and with diabetic diarrhea,but was not increased in diabetics without neuropathy compared to controls. J.Japan Diab.Soc.26(9): 1983