Bowel functions, fecal unconjugated primary and secondary bile acids, and colonic transit in patients with irritable bowel syndrome

Andrea Shin, Michael Camilleri, Priya Vijayvargiya, Irene Busciglio, Duane Burton, Michael Ryks, Deborah Rhoten, Alan Lueke, Amy Saenger, Adam Girtman, Alan R. Zinsmeister

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Background & Aims: There is an unclear relationship among bowel symptoms, excretion of unconjugated fecal bile acid (UBA), and colonic transit in irritable bowel syndrome (IBS). We measured total and main individual UBA in fecal samples of patients with IBS and assessed relationships among stool frequency or consistency, fecal UBA (total and individual), and colonic transit. Methods: In this study 30 healthy volunteers (controls), 31 subjects with IBS with diarrhea (IBS-D), and 30 with IBS with constipation (IBS-C) were placed on 4-day diets containing 100 g fat; we measured stool characteristics, total fecal UBA and fat levels, and overall colonic transit. We assessed univariate associations of total and individual levels of fecal UBA with phenotype (controls, IBS-D, IBS-C) by using the Kruskal-Wallis test; associations between end points were assessed by using Spearman correlations. With response surface regression models, we assessed relationships between stool, colonic transit, and fecal total and secretory UBA. Results: There was a significant association between total fecal UBA and phenotype ( P= .029); the association was greater for IBS-D than IBS-C, compared with controls. Fecal levels of primary UBAs (cholic and chenodeoxycholic acids) were higher in subjects with IBS-D, compared with controls (both P < .01). Levels of fecal secretory UBAs (chenodeoxycholic acid, P= .019; deoxycholic acid, P= .025) were lower in subjects with IBS-C compared with controls, whereas levels of the nonsecretory UBA, lithocholic acid, were higher ( P= .020). There were significant univariate associations between stool number and form and total fecal UBA (including percentages of lithocholic acid, chenodeoxycholic acid and cholic acid), fecal fat, and colonic transit at 24 and 48 hours after eating. In the regression models, the relative contribution of colonic transit was consistently greater and largely independent of the contribution of bile acids. Conclusions: Measurements of individual UBAs identify changes associated with stool characteristics in patients with IBS; these effects are independent of the effects of colonic transit.

Original languageEnglish (US)
Pages (from-to)1270-1275
Number of pages6
JournalClinical Gastroenterology and Hepatology
Volume11
Issue number10
DOIs
StatePublished - Oct 2013

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Irritable Bowel Syndrome
Bile Acids and Salts
Lithocholic Acid
Chenodeoxycholic Acid
Fats
Cholic Acids
Phenotype
Cholic Acid
Deoxycholic Acid
Constipation
Diarrhea
Healthy Volunteers
Eating
Diet

Keywords

  • Abdominal Pain
  • Constipation
  • Diarrhea
  • Secretory

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Bowel functions, fecal unconjugated primary and secondary bile acids, and colonic transit in patients with irritable bowel syndrome. / Shin, Andrea; Camilleri, Michael; Vijayvargiya, Priya; Busciglio, Irene; Burton, Duane; Ryks, Michael; Rhoten, Deborah; Lueke, Alan; Saenger, Amy; Girtman, Adam; Zinsmeister, Alan R.

In: Clinical Gastroenterology and Hepatology, Vol. 11, No. 10, 10.2013, p. 1270-1275.

Research output: Contribution to journalArticle

Shin, A, Camilleri, M, Vijayvargiya, P, Busciglio, I, Burton, D, Ryks, M, Rhoten, D, Lueke, A, Saenger, A, Girtman, A & Zinsmeister, AR 2013, 'Bowel functions, fecal unconjugated primary and secondary bile acids, and colonic transit in patients with irritable bowel syndrome', Clinical Gastroenterology and Hepatology, vol. 11, no. 10, pp. 1270-1275. https://doi.org/10.1016/j.cgh.2013.04.020
Shin, Andrea ; Camilleri, Michael ; Vijayvargiya, Priya ; Busciglio, Irene ; Burton, Duane ; Ryks, Michael ; Rhoten, Deborah ; Lueke, Alan ; Saenger, Amy ; Girtman, Adam ; Zinsmeister, Alan R. / Bowel functions, fecal unconjugated primary and secondary bile acids, and colonic transit in patients with irritable bowel syndrome. In: Clinical Gastroenterology and Hepatology. 2013 ; Vol. 11, No. 10. pp. 1270-1275.
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abstract = "Background & Aims: There is an unclear relationship among bowel symptoms, excretion of unconjugated fecal bile acid (UBA), and colonic transit in irritable bowel syndrome (IBS). We measured total and main individual UBA in fecal samples of patients with IBS and assessed relationships among stool frequency or consistency, fecal UBA (total and individual), and colonic transit. Methods: In this study 30 healthy volunteers (controls), 31 subjects with IBS with diarrhea (IBS-D), and 30 with IBS with constipation (IBS-C) were placed on 4-day diets containing 100 g fat; we measured stool characteristics, total fecal UBA and fat levels, and overall colonic transit. We assessed univariate associations of total and individual levels of fecal UBA with phenotype (controls, IBS-D, IBS-C) by using the Kruskal-Wallis test; associations between end points were assessed by using Spearman correlations. With response surface regression models, we assessed relationships between stool, colonic transit, and fecal total and secretory UBA. Results: There was a significant association between total fecal UBA and phenotype ( P= .029); the association was greater for IBS-D than IBS-C, compared with controls. Fecal levels of primary UBAs (cholic and chenodeoxycholic acids) were higher in subjects with IBS-D, compared with controls (both P < .01). Levels of fecal secretory UBAs (chenodeoxycholic acid, P= .019; deoxycholic acid, P= .025) were lower in subjects with IBS-C compared with controls, whereas levels of the nonsecretory UBA, lithocholic acid, were higher ( P= .020). There were significant univariate associations between stool number and form and total fecal UBA (including percentages of lithocholic acid, chenodeoxycholic acid and cholic acid), fecal fat, and colonic transit at 24 and 48 hours after eating. In the regression models, the relative contribution of colonic transit was consistently greater and largely independent of the contribution of bile acids. Conclusions: Measurements of individual UBAs identify changes associated with stool characteristics in patients with IBS; these effects are independent of the effects of colonic transit.",
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AU - Shin, Andrea

AU - Camilleri, Michael

AU - Vijayvargiya, Priya

AU - Busciglio, Irene

AU - Burton, Duane

AU - Ryks, Michael

AU - Rhoten, Deborah

AU - Lueke, Alan

AU - Saenger, Amy

AU - Girtman, Adam

AU - Zinsmeister, Alan R.

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N2 - Background & Aims: There is an unclear relationship among bowel symptoms, excretion of unconjugated fecal bile acid (UBA), and colonic transit in irritable bowel syndrome (IBS). We measured total and main individual UBA in fecal samples of patients with IBS and assessed relationships among stool frequency or consistency, fecal UBA (total and individual), and colonic transit. Methods: In this study 30 healthy volunteers (controls), 31 subjects with IBS with diarrhea (IBS-D), and 30 with IBS with constipation (IBS-C) were placed on 4-day diets containing 100 g fat; we measured stool characteristics, total fecal UBA and fat levels, and overall colonic transit. We assessed univariate associations of total and individual levels of fecal UBA with phenotype (controls, IBS-D, IBS-C) by using the Kruskal-Wallis test; associations between end points were assessed by using Spearman correlations. With response surface regression models, we assessed relationships between stool, colonic transit, and fecal total and secretory UBA. Results: There was a significant association between total fecal UBA and phenotype ( P= .029); the association was greater for IBS-D than IBS-C, compared with controls. Fecal levels of primary UBAs (cholic and chenodeoxycholic acids) were higher in subjects with IBS-D, compared with controls (both P < .01). Levels of fecal secretory UBAs (chenodeoxycholic acid, P= .019; deoxycholic acid, P= .025) were lower in subjects with IBS-C compared with controls, whereas levels of the nonsecretory UBA, lithocholic acid, were higher ( P= .020). There were significant univariate associations between stool number and form and total fecal UBA (including percentages of lithocholic acid, chenodeoxycholic acid and cholic acid), fecal fat, and colonic transit at 24 and 48 hours after eating. In the regression models, the relative contribution of colonic transit was consistently greater and largely independent of the contribution of bile acids. Conclusions: Measurements of individual UBAs identify changes associated with stool characteristics in patients with IBS; these effects are independent of the effects of colonic transit.

AB - Background & Aims: There is an unclear relationship among bowel symptoms, excretion of unconjugated fecal bile acid (UBA), and colonic transit in irritable bowel syndrome (IBS). We measured total and main individual UBA in fecal samples of patients with IBS and assessed relationships among stool frequency or consistency, fecal UBA (total and individual), and colonic transit. Methods: In this study 30 healthy volunteers (controls), 31 subjects with IBS with diarrhea (IBS-D), and 30 with IBS with constipation (IBS-C) were placed on 4-day diets containing 100 g fat; we measured stool characteristics, total fecal UBA and fat levels, and overall colonic transit. We assessed univariate associations of total and individual levels of fecal UBA with phenotype (controls, IBS-D, IBS-C) by using the Kruskal-Wallis test; associations between end points were assessed by using Spearman correlations. With response surface regression models, we assessed relationships between stool, colonic transit, and fecal total and secretory UBA. Results: There was a significant association between total fecal UBA and phenotype ( P= .029); the association was greater for IBS-D than IBS-C, compared with controls. Fecal levels of primary UBAs (cholic and chenodeoxycholic acids) were higher in subjects with IBS-D, compared with controls (both P < .01). Levels of fecal secretory UBAs (chenodeoxycholic acid, P= .019; deoxycholic acid, P= .025) were lower in subjects with IBS-C compared with controls, whereas levels of the nonsecretory UBA, lithocholic acid, were higher ( P= .020). There were significant univariate associations between stool number and form and total fecal UBA (including percentages of lithocholic acid, chenodeoxycholic acid and cholic acid), fecal fat, and colonic transit at 24 and 48 hours after eating. In the regression models, the relative contribution of colonic transit was consistently greater and largely independent of the contribution of bile acids. Conclusions: Measurements of individual UBAs identify changes associated with stool characteristics in patients with IBS; these effects are independent of the effects of colonic transit.

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