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Cholesterol Absorption and Cholesterol and Bile Acid Synthesis in Two Brothers With IDDM and Diarrhea

OBJECTIVE To determine the best possible treatment for two brothers who had IDDM and bile acid malabsorption-associated disabling diarrhea that was resistant to cholestyramine, antibiotics, clonidine, loperamide, or anticholinergic drugs. RESEARCH DESIGN AND METHODS Our study paired these two brothers with control subjects. Serum noncholesterol sterols and fecal elimination of cholesterol and plant sterols were quantitated by gas-liquid chromatography. RESULTS Fecal losses of bile acids exceeded four to six times the control values, and cholesterol synthesis was increased two to three times. Cholesterol absorption efficiency and serum cholesterol concentrations were, respectively, within the high and low control range. CONCLUSIONS Bile acid malabsorption might have resulted from deranged intestinal motility, possibly contributed by gastrointestinal neuropathy, and some genetic factor.