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Colonic Energy Salvage in Chronic Pancreatic Exocrine Insufficiency

P. M. O. Owira, MSc(Med)^* and T. A. Winter, MD, PhD

From the ^* GI Clinic and Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; and the Division of Digestive Diseases and Nutrition, University of Kentucky

Correspondence: Peter M. Owira, MSc(Med), Department of Pharmacology, University of KwanZulu, Private Bag X 54001, Durban, South Africa 4000. Electronic mail may be sent to owirap{at}ukzn.ac.za.

Background: Chronic pancreatic exocrine insufficiency results in maldigestion. As a result, increased amounts of undigested nutrients reach the colon, providing more substrate for bacterial fermentation to produce short-chain fatty acids, which could therefore provide additional energy supplement. Methods: This study aimed to assess carbohydrate malabsorption in patients with chronic pancreatic exocrine insufficiency after ingestion of a standard diet and to calculate energy salvaged by colonic bacterial metabolism. A 72-hour stool collection was done on 10 adult patients receiving a 3-day standard diet containing 100 g fat, 329 g carbohydrate, and 154 g protein, and short-chain fatty acids, fat, carbohydrate, and nitrogen excretion were assessed. A breath hydrogen test after ingestion of 200 g (dry weight) cooked maize meal (test meal) and 10 g oral inulin (standard), respectively, was subsequently done on the patients and 15 healthy adult controls. Results: Breath hydrogen production after ingestion of maize meal and inulin, respectively, and calculated carbohydrate malabsorption were significantly greater in patients (21.4% ± 17%) than in controls (10.2 ± 1.4%; p < .05). Patients malabsorbed 70.4 g/d (281.6 kcal) carbohydrate in the standard diet. Total carbohydrate loss in stool amounted to 8.1 g/d (2.4%), and 62.3 g/d (19%) was hence salvaged as short-chain fatty acids for energy provision. Colonic bacterial fermentation therefore converted 88.5% of malabsorbed carbohydrate to short-chain fatty acids, 92.8% of which was absorbed and 7.2% excreted. This suggests that 10.2% of energy expenditure/requirement in these patients is derived from salvage of malabsorbed carbohydrate. Conclusions: Colonic bacterial metabolism is a significant source of energy salvage in patients with pancreatic enzyme deficiency.

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