Synthetic detergents in bile-salt-deficient steatorrhoea.

1. Fat malabsorption caused by bile-salt deficiency is not easily corrected by standard therapy. It has been shown in rats with bile-salt deficiency that non-ionic detergents can replace bile salts and improve fat absorption. A careful assessment of the place of synthetic detergents such as Tween in human therapy has not been reported. 2. The effects of Tween were studied in 13 patients with bile-salt-deficient steatorrhoea, eight of whom received Tween 80 and five Tween 20. 3. Tween therapy reduced steatorrhoea in 10/13 patients; a mean decrease in faecal fat of 33% was achieved with best effect seen in patients with severe steatorrhoea. 4. In the five patients given Tween 20, duodenal/jejunal intubation was conducted using meals with or without added Tween. Jejunal bile salt concentrations were low in all subjects and Tween had no effect on bile-salt output. 5. With Tween addition micellar free fatty acids and phospholipids were increased in four out of the five patients (mean increases 100% and 260% respectively). The mean ratio of fatty acid to bile salt increased from 1.26 to 3-53 and of phospholipid to bile salt from 0.09 to 0.21 in the presence of Tween. 6. The results suggest that in steatorrhoea due to bile-salt deficiency Tween causes increased micellization of ingested fat and improvement in fat absorption. 7. Tween and other non-ionic detergents may, therefore, find a place in therapy of bile-salt deficiency.