Bile acid replacement therapy with cholylsarcosine for short-bowel syndrome

Scand J Gastroenterol. 1999 Aug;34(8):818-23. doi: 10.1080/003655299750025769.


Background: Fat malabsorption in the short-bowel syndrome (SBS) may in part be caused by decreased bile secretion. Cholylsarcosine is a synthetic conjugated bile acid resistant to bacterial degradation with no cathartic activity.

Methods: Metabolic balance studies were performed in four patients with SBS, two with a colon and two with a jejunostomy.

Results: Treatment with cholylsarcosine, 6 and 12 g/day, increased fat absorption by 17 +/- 3 g/day (0.7 MJ/day; P <0.05) and 20+/-1 g/day (0.8 MJ/day; P <0.001; mean +/- standard error), respectively, to a total absorption of energy from fat of 2.0-2.2 MJ/day. Total absorption of energy increased from 11.0 MJ/day to 11.7 MJ/day (bomb calorimetry). Energy absorbed from carbohydrates (6.5 MJ/day) did not change. Faecal output increased in one of the patients with a colon and was unchanged in the other three patients. A higher percentage of the medium-chain and the unsaturated fatty acids were absorbed in comparison with the long-chain and the saturated fatty acids (100% of C8:0, 92% of C10:0, 74% of C12:0, 52% of C14:0, 30% of C16:0, 16% of C18:0, and 47% of unsaturated C18 fatty acids). Treatment with cholylsarcosine increased absorption of C14:0 by 23%-29%, of C16:0 by 59%-74%, of C18:0 by 125%-138%, and of unsaturated C18-fatty acids by 36%-45%. A fifth patient (without a colon) was enrolled in the study but had to be excluded because cholylsarcosine, 6 g/day, resulted in nausea and anorexia.

Conclusion: Cholylsarcosine increased fat absorption in SBS. The effect was relatively more pronounced on absorption of the low-absorbable, longer-chained, and saturated fatty acids. The overall gain in absorption of energy was small (6%) because energy absorption from carbohydrates was threefold higher than that from fat. Cholylsarcosine may have cathartic effects on some SBS patients with a colon. The maximal efficacy of cholylsarcosine was reached at a dose of 6 g/day, compared with 12 g/day in three of four patients.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Analysis of Variance
  • Calorimetry
  • Cholic Acids / therapeutic use*
  • Cross-Over Studies
  • Dietary Fats / analysis
  • Energy Intake
  • Energy Metabolism
  • Fats / analysis
  • Feces / chemistry
  • Female
  • Food, Formulated / analysis
  • Humans
  • Intestinal Absorption / drug effects
  • Male
  • Middle Aged
  • Sarcosine / analogs & derivatives*
  • Sarcosine / therapeutic use
  • Short Bowel Syndrome / drug therapy*
  • Short Bowel Syndrome / physiopathology


  • Cholic Acids
  • Dietary Fats
  • Fats
  • cholylsarcosine
  • Sarcosine