van der Wulp MY, Derrien M, Stellaard F, Wolters H, Kleerebezem M, Dekker J, Rings EH, Groen AK, Verkade HJ. Laxative treatment with polyethylene glycol decreases microbial primary bile salt dehydroxylation and lipid metabolism in the intestine of rats. Am J Physiol Gastrointest Liver Physiol 305: G474 -G482, 2013. First published July 18, 2013; doi:10.1152/ajpgi.00375.2012.-Polyethylene glycol (PEG) is a frequently used osmotic laxative that accelerates gastrointestinal transit. It has remained unclear, however, whether PEG affects intestinal functions. We aimed to determine the effect of PEG treatment on intestinal sterol metabolism. Rats were treated with PEG in drinking water (7%) for 2 wk or left untreated (controls). We studied the enterohepatic circulation of the major bile salt (BS) cholate with a plasma stable isotope dilution technique and determined BS profiles and concentrations in bile, intestinal lumen contents, and feces. We determined the fecal excretion of cholesterol plus its intestinally formed metabolites. Finally, we determined the cytolytic activity of fecal water (a surrogate marker of colorectal cancer risk) and the amount and composition of fecal microbiota. Compared with control rats, PEG treatment increased the pool size (ϩ51%; P Ͻ 0.01) and decreased the fractional turnover of cholate (Ϫ32%; P Ͻ 0.01). PEG did not affect the cholate synthesis rate, corresponding with an unaffected fecal primary BS excretion. PEG reduced fecal excretion of secondary BS and of cholesterol metabolites (each P Ͻ 0.01). PEG decreased the cytolytic activity of fecal water [54 (46 -62) vs. 87 (85-92)% erythrocyte potassium release in PEG-treated and control rats, respectively; P Ͻ 0.01]. PEG treatment increased the contribution of Verrucomicrobia (P Ͻ 0.01) and decreased that of Firmicutes (P Ͻ 0.01) in fecal flora. We concluded that PEG treatment changes the intestinal bacterial composition, decreases the bacterial dehydroxylation of primary BS and the metabolism of cholesterol, and increases the pool size of the primary BS cholate in rats.cholate; enterohepatic circulation; bile salt; microbiota POLYETHYLENE GLYCOL (PEG) presently is one of the most widely prescribed laxatives. Long-term treatment with PEG is believed to be safe and highly effective (11,27). However, it is not known whether or not long-term PEG treatment affects specific intestinal metabolic functions. PEG may change the intestinal milieu by accelerating the passage of luminal contents and/or by increasing the luminal water content, possibly leading to a change in the intestinal microflora (10).We have previously shown that PEG treatment accelerates the transit through the small intestine as well as the whole gut in rats (10). PEG decreases fecal excretion of bile salts (BS) in rats (10). BS facilitate the solubilization of lipids (dietary fats, cholesterol, and fat-soluble vitamins) in the small intestine, which is required for efficient lipid absorption (41). It has recently become clear that BS not only are detergents necessary for lip...