Increased Fecal Bile Acid Excretion in a Significant Subset of Patients with Other Inflammatory Diarrheal Diseases

Priya Vijayvargiya, Daniel Gonzalez Izundegui, Gerardo Calderon, Sarah Tawfic, Sarah Batbold, Hiba Saifuddin, Patrick Duggan, Valeria Melo, Taylor Thomas, Megan Heeney, Adrian Beyde, James Miller, Kenneth Valles, Kafayat Oyemade, Joseph F. Brant, Jessica Atieh, Leslie J. Donato, Michael Camilleri

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Increased fecal bile acid excretion (IBAX) occurs in a third of patients with functional diarrhea. Aims: To assess the prevalence of IBAX in benign inflammatory intestinal and colonic diseases presenting with chronic diarrhea. Methods: All patients with known inflammatory diseases or resections who underwent 48 h fecal fat and BA testing for chronic diarrhea at a single center were included. Quiescent disease was based on clinical evaluation and serum, endoscopic and imaging studies. IBAX was defined by: > 2337 µmol total BA/48 h; or primary fecal BAs > 10%; or > 4% primary BA plus > 1000 µmol total BA /48 h. Demographics, fecal weight, fecal fat, stool frequency and consistency were collected. Nonparametric statistical analyses were used for group comparisons. Results: Sixty patients had celiac disease (51 quiescent, 9 active), 66 microscopic colitis (MC: 34 collagenous, 32 lymphocytic), 18 ulcerative colitis (UC), and 47 Crohn’s disease (CD). Overall, fecal fat, 48 h stool weight, frequency and consistency were not different among subgroups except for inflammatory bowel disease (IBD) based on disease location. Almost 50% patients with celiac disease and MC had IBAX, with a greater proportion with increased primary fecal BA. Among UC patients, rates of IBAX were higher with pancolonic disease. A high proportion of patients with ileal resection or CD affecting ileum or colon had IBAX. IBAX was present even with quiescent inflammation in UC or CD. Conclusions: A significant subset of patients with MC, quiescent celiac disease and IBD had increased fecal BA excretion, a potential additional therapeutic target for persistent diarrhea.

Original languageEnglish (US)
JournalDigestive diseases and sciences
DOIs
StateAccepted/In press - 2021

Keywords

  • Celiac
  • Colitis
  • Collagenous
  • Crohn's
  • Lymphocytic
  • Microscopic
  • Ulcerative

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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