Cholestyramine Treatment of Diarrhea Associated with Ileal Resection

Abstract The efficacy of cholestyramine as treatment for diarrhea in patients with ileal resection was examined by inpatient and outpatient trials. Ten of 12 patients having less than 100 cm of distal ileum resected and some remaining ascending colon responded to cholestyramine, 16 gm per day, by a significant decrease in fecal frequency or fecal weight or both. By contrast, none of eight patients having resections of more than 100 cm of ileum responded. The degree of steatorrhea was also of predictive value since all eight patients with fecal fat excretion less than 20 gm per day responded, whereas none of five patients with greater steatorrhea responded. Cholestyramine is useful symptomatic treatment for diarrhea in patients with small ileal resections and mild steatorrhea. The response may be further evidence that diarrhea in these patients is caused by bile acid malabsorption resulting in increased passage of bile acids into the colon, where they induce secretion of salt and water.