Effects of hemicolectomy on bile acid metabolism in relation to colon carcinogenesis in man

Bile acids are probably important in colon carcinogenesis. Regional differences in bile acid metabolism within the colon were studied to illuminate the preferential distal occurrence of colon cancer in Western countries. Faeces (24 h) were collected for bile acid measurement from 25 patients with hemicolectomy (nine left and 16 right) and 17 adenoma patients with an intact colon (control subjects). Duodenal bile and cytolytic and alkaline phosphatase activity of faecal water were also studied. The median percentage of deoxycholic acid (DCA) was lower in the hemicolectomy groups [left 48% (range 38-57%), right 45% (2-62%) vs. control subjects 59% (38-70%), P < 0.05]. In duodenal bile, the proportion of DCA in left [4% (1-25%)] was lower than in the patients with right hemicolectomy [19% (0-69%)] and control subjects [24% (7-50%)], P < 0.05. Faecal concentration of protonated DCA was higher in those with right hemicolectomy (0.101 mu mol g(-1)) than in those with left hemicolectomy (0.048 mol g(-)1), which coincided with a higher cytolytic [right 49% (3-93%), left 2% (1-37%)] and alkaline phosphatase activity [right 6.7 U mL(-1) (1.2-40.1 U mL(-1)), left (2.0 U mL(-1) (1-25.7 U mL(-1)), both P < 0.02]. These findings suggest differences in bile acid metabolism between the proximal and distal colon that may contribute to the disparity in cancer risk.