Jejunoileal bypass

Short bowel Intestinal resection (e.g. for Crohn s disease, volvulus, intussusception or infarction) Jejunoileal bypass for obesity... 

Enteric hyperoxaluria refers to a state in which oxalate is over-absorbed in the bowel because of a defect in absorption of fat and bile adds. In those patients, suffering from Crohn s disease or patients with jejunoileal bypass [14, 15], Ca is complexated to fatty (bile) acids by which Ca-oxalate is no longer formed making oxalate available for intestinal absorption. Daily oxalate excretion is in between that of healthy volunteers and... 

Minerals require a suitable mucosal surface across which to enter the body. Resection or diversion of a large portion of small bowel obviously affects mineral absorption. Extensive mucosal damage due to mesenteric infarction or inflamatory bowel disease or major diversion by jejunoileal bypass procedures reduces the available surface area. Minerals whose absorption occurs primarily in the proximal intestine, e.g., copper or iron, are affected differently than those absorbed more distally, e.g., zinc. In addition, the integrity of the epithelium, the uptake of fluids and electrolytes, the intracellular protein synthesis, the energy-dependent pumps, and the hormone receptors must be intact. 

This unusual form of lactic acidosis is due to increased production and accumulation of D-lactate in circulation. The normal isomer synthesized in the human body is L-lactate but the D-lactate isomer can occur in patients with jejunoileal bypass, small bowel resection, or other types of short bowel syndrome. In these patients, ingested starch and glucose bypass the normal metabolism in the small intestine and lead to increased delivery of nutrients to the colon where gram-positive, anaerobic bacteria (e.g., Lactobacilli) ferment glucose to D-lactate. The D-lactate is absorbed via the portal circulation. 

Read, Goblet cell hyperplasia is a feature of the adaptive response to jejunoileal bypass in rats. Gut, 25 62-68 (1984). 

Griffen, Increased potential for carcinoma of the colon in rats following jejunoileal bypass, Surg.Forum, 83 382-383 (1982). 

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