Advances in understanding of bile acid diarrhea

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Bile acids (BA) are actively reabsorbed in the terminal ileum by the apical Na+-dependent bile salt transporter. This review addresses the epidemiology, pathophysiology, diagnosis and treatment of BA diarrhea (BAD). BAD is typically caused by ileal resection or disease; 25-33% of patients with chronic functional diarrhea or irritable bowel syndrome-diarrhea (IBS-D) have BAD, possibly from deficiency in the ileal hormone, FGF-19, which normally provides feedback inhibition of BA synthesis. Diagnosis of BAD is typically based on reduced BA retention of radiolabeled BA (75SeHCAT), increased BA synthesis (serum C4) or increased fecal BA loss. In clinical practice, diagnosis is often based on response to BA sequestrants (e.g., cholestyramine or colesevelam). Diagnostic tests for BA malabsorption (BAM) need to be used more extensively in clinical practice. In the future, farnesoid X receptor agonists that stimulate ileal production of FGF-19 may be alternative treatments of BAD.

Original languageEnglish (US)
Pages (from-to)49-61
Number of pages13
JournalExpert Review of Gastroenterology and Hepatology
Volume8
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Bile Acids and Salts
Diarrhea
Cholestyramine Resin
Irritable Bowel Syndrome
Ileum
Routine Diagnostic Tests
Epidemiology
Hormones
Therapeutics

Keywords

  • ASBT
  • CDCA
  • colesevelam
  • DCA
  • FGF-19
  • FXR
  • IBAT
  • obeticholic acid
  • secretion
  • sequestrants

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Advances in understanding of bile acid diarrhea. / Camilleri, Michael.

In: Expert Review of Gastroenterology and Hepatology, Vol. 8, No. 1, 01.2014, p. 49-61.

Research output: Contribution to journalArticle

@article{ca1f431aad1440c583d79cd447dd1d68,
title = "Advances in understanding of bile acid diarrhea",
abstract = "Bile acids (BA) are actively reabsorbed in the terminal ileum by the apical Na+-dependent bile salt transporter. This review addresses the epidemiology, pathophysiology, diagnosis and treatment of BA diarrhea (BAD). BAD is typically caused by ileal resection or disease; 25-33{\%} of patients with chronic functional diarrhea or irritable bowel syndrome-diarrhea (IBS-D) have BAD, possibly from deficiency in the ileal hormone, FGF-19, which normally provides feedback inhibition of BA synthesis. Diagnosis of BAD is typically based on reduced BA retention of radiolabeled BA (75SeHCAT), increased BA synthesis (serum C4) or increased fecal BA loss. In clinical practice, diagnosis is often based on response to BA sequestrants (e.g., cholestyramine or colesevelam). Diagnostic tests for BA malabsorption (BAM) need to be used more extensively in clinical practice. In the future, farnesoid X receptor agonists that stimulate ileal production of FGF-19 may be alternative treatments of BAD.",
keywords = "ASBT, CDCA, colesevelam, DCA, FGF-19, FXR, IBAT, obeticholic acid, secretion, sequestrants",
author = "Michael Camilleri",
year = "2014",
month = "1",
doi = "10.1586/17474124.2014.851599",
language = "English (US)",
volume = "8",
pages = "49--61",
journal = "Expert Review of Gastroenterology and Hepatology",
issn = "1747-4124",
publisher = "Expert Reviews Ltd.",
number = "1",

}

TY - JOUR

T1 - Advances in understanding of bile acid diarrhea

AU - Camilleri, Michael

PY - 2014/1

Y1 - 2014/1

N2 - Bile acids (BA) are actively reabsorbed in the terminal ileum by the apical Na+-dependent bile salt transporter. This review addresses the epidemiology, pathophysiology, diagnosis and treatment of BA diarrhea (BAD). BAD is typically caused by ileal resection or disease; 25-33% of patients with chronic functional diarrhea or irritable bowel syndrome-diarrhea (IBS-D) have BAD, possibly from deficiency in the ileal hormone, FGF-19, which normally provides feedback inhibition of BA synthesis. Diagnosis of BAD is typically based on reduced BA retention of radiolabeled BA (75SeHCAT), increased BA synthesis (serum C4) or increased fecal BA loss. In clinical practice, diagnosis is often based on response to BA sequestrants (e.g., cholestyramine or colesevelam). Diagnostic tests for BA malabsorption (BAM) need to be used more extensively in clinical practice. In the future, farnesoid X receptor agonists that stimulate ileal production of FGF-19 may be alternative treatments of BAD.

AB - Bile acids (BA) are actively reabsorbed in the terminal ileum by the apical Na+-dependent bile salt transporter. This review addresses the epidemiology, pathophysiology, diagnosis and treatment of BA diarrhea (BAD). BAD is typically caused by ileal resection or disease; 25-33% of patients with chronic functional diarrhea or irritable bowel syndrome-diarrhea (IBS-D) have BAD, possibly from deficiency in the ileal hormone, FGF-19, which normally provides feedback inhibition of BA synthesis. Diagnosis of BAD is typically based on reduced BA retention of radiolabeled BA (75SeHCAT), increased BA synthesis (serum C4) or increased fecal BA loss. In clinical practice, diagnosis is often based on response to BA sequestrants (e.g., cholestyramine or colesevelam). Diagnostic tests for BA malabsorption (BAM) need to be used more extensively in clinical practice. In the future, farnesoid X receptor agonists that stimulate ileal production of FGF-19 may be alternative treatments of BAD.

KW - ASBT

KW - CDCA

KW - colesevelam

KW - DCA

KW - FGF-19

KW - FXR

KW - IBAT

KW - obeticholic acid

KW - secretion

KW - sequestrants

UR - http://www.scopus.com/inward/record.url?scp=84893080876&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893080876&partnerID=8YFLogxK

U2 - 10.1586/17474124.2014.851599

DO - 10.1586/17474124.2014.851599

M3 - Article

C2 - 24410472

AN - SCOPUS:84893080876

VL - 8

SP - 49

EP - 61

JO - Expert Review of Gastroenterology and Hepatology

JF - Expert Review of Gastroenterology and Hepatology

SN - 1747-4124

IS - 1

ER -