Therap Adv Gastroenterol. 2010 Nov;3(6):349-57. doi: 10.1177/1756283X10377126.
Managing bile acid diarrhoea.
Therapeutic advances in gastroenterology
Julian R F Walters, Sanjeev S Pattni
Affiliations
Affiliations
- Section of Hepatology and Gastroenterology, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
PMID: 21180614
PMCID: PMC3002596 DOI: 10.1177/1756283X10377126
Abstract
Bowel symptoms including diarrhoea can be produced when excess bile acids (BA) are present in the colon. This condition, known as bile acid or bile salt malabsorption, has been under recognized, as the best diagnostic method, the (75)Se-homocholic acid taurine (SeHCAT) test, is not available in many countries and is not fully utilized in others. Reduced SeHCAT retention establishes that this is a complication of many other gastrointestinal diseases. Repeated studies show SeHCAT tests are abnormal in about 30% of patients otherwise diagnosed as diarrhoea-predominant irritable bowel syndrome or functional diarrhoea, with an estimated population prevalence of around 1%. Recent work suggests that the condition previously called idiopathic bile acid malabsorption (BAM) is not in fact due to a defect in absorption, but results from an overproduction of BA because of defective feedback inhibition of hepatic bile acid synthesis, a function of the ileal hormone fibroblast growth factor 19 (FGF19). The approach to treatment currently depends on binding excess BA, to reduce their secretory actions, using colestyramine, colestipol and, most recently, colesevelam. Colesevelam has a number of potential advantages that merit further investigation in trials directed at patients with bile acid diarrhoea.
Keywords: Crohn's disease; SeHCAT; bile acids; colesevelam; colestipol; colestyramine; fibroblast growth factor 19; functional diarrhoea; irritable bowel syndrome; malabsorption
References
- Postgrad Med J. 1992 Apr;68(798):272-6 - PubMed
- Eur J Gastroenterol Hepatol. 1996 Feb;8(2):117-23 - PubMed
- Aliment Pharmacol Ther. 2009 Oct;30(7):707-17 - PubMed
- Am J Gastroenterol. 2010 Apr;105(4):775-85 - PubMed
- Eur J Gastroenterol Hepatol. 2008 May;20(5):413-22 - PubMed
- Lancet Oncol. 2007 Nov;8(11):1007-17 - PubMed
- Gut. 2000 Feb;46(2):170-5 - PubMed
- Hepatology. 2009 May;49(5):1403-18 - PubMed
- J Lipid Res. 2007 Dec;48(12):2693-700 - PubMed
- Gut. 1987 Aug;28(8):970-5 - PubMed
- Scand J Gastroenterol Suppl. 1992;194:66-70 - PubMed
- Aliment Pharmacol Ther. 1998 Sep;12(9):839-44 - PubMed
- Proc Natl Acad Sci U S A. 2006 Mar 7;103(10):3920-5 - PubMed
- Clin Med (Lond). 2010 Apr;10(2):124-6 - PubMed
- Neurogastroenterol Motil. 2009 Jul;21(7):734-e43 - PubMed
- J R Coll Physicians Lond. 1997 Jan-Feb;31(1):53-6 - PubMed
- Acta Physiol (Oxf). 2009 Oct;197(2):129-37 - PubMed
- Gut. 1976 Dec;17(12):965-70 - PubMed
- J Clin Invest. 1997 Apr 15;99(8):1880-7 - PubMed
- Arch Intern Med. 1999 Sep 13;159(16):1893-900 - PubMed
- J Nucl Med. 1981 Aug;22(8):720-5 - PubMed
- Dig Dis Sci. 1999 Jan;44(1):14-9 - PubMed
- Cell Metab. 2005 Oct;2(4):217-25 - PubMed
- Scand J Gastroenterol. 1999 Jun;34(6):587-90 - PubMed
- Gut. 1991 May;32(5):500-3 - PubMed
- Scand J Gastroenterol. 1993 Oct;28(10):865-8 - PubMed
- J R Coll Physicians Lond. 2000 Sep-Oct;34(5):448-51 - PubMed
- Clin Gastroenterol Hepatol. 2010 Feb;8(2):159-65 - PubMed
- Lancet. 1977 Dec 10;2(8050):1193-5 - PubMed
- Am J Gastroenterol. 2004 Apr;99(4):711-8 - PubMed
- J Intern Med. 2006 Dec;260(6):530-6 - PubMed
- Eur J Gastroenterol Hepatol. 2006 Apr;18(4):397-403 - PubMed
- Clin Gastroenterol Hepatol. 2009 Nov;7(11):1189-94 - PubMed
- Dig Dis Sci. 2001 Oct;46(10):2231-8 - PubMed
- Gastroenterology. 1967 Apr;52(4):752-7 - PubMed
- Gut. 1991 Oct;32(10):1180-7 - PubMed
- Eur J Gastroenterol Hepatol. 2000 May;12(5):541-7 - PubMed
- Dan Med Bull. 1973 Dec;20(6):174-7 - PubMed
- Curr Treat Options Gastroenterol. 2007 Feb;10(1):28-33 - PubMed
- Br Med J (Clin Res Ed). 1985 May 4;290(6478):1315-8 - PubMed
- Scand J Gastroenterol. 2003 Aug;38(8):826-30 - PubMed
- Clin Gastroenterol. 1986 Jul;15(3):567-82 - PubMed
- Expert Rev Gastroenterol Hepatol. 2009 Oct;3(5):461-4 - PubMed
- Gut. 1991 Sep;32(9):1004-6 - PubMed
- Gut. 2005 Mar;54(3):441-2 - PubMed
- World J Gastroenterol. 2006 Dec 21;12(47):7710-4 - PubMed
- N Engl J Med. 1969 Aug 21;281(8):397-402 - PubMed
- Scand J Gastroenterol. 2001 Oct;36(10):1077-80 - PubMed
- Gut. 2004 Jan;53(1):78-84 - PubMed
- Br Med J (Clin Res Ed). 1985 Mar 2;290(6469):665-8 - PubMed
- Digestion. 2004;69(4):211-8 - PubMed
- Br Med Bull. 2009;92:79-93 - PubMed
- Am J Manag Care. 1999 Apr;5(4):437-44 - PubMed
- Aliment Pharmacol Ther. 2006 Dec;24(11-12):1643-9 - PubMed
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