Bile Acid Sequestrant Therapy in Microscopic Colitis

Northcutt, Michael; Gentile, Nicole; Goldstein, Jay L.; Yen, Eugene F.

doi:10.1097/mcg.0000000000001496

Cited by 13 publications

(6 citation statements)

References 32 publications

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“…BASs are cross-linked positively charged polymeric materials that control cholesterol levels in an indirect way by their ability to bind BA salts in the small intestine [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. The BAS–BA complex is eliminated from the body through excretion, which causes the decrease in BA.…”

Section: Lipid-lowering Drugsmentioning

confidence: 99%

Bile Acid Sequestrants Based on Natural and Synthetic Gels

Stanciu¹,

Nichifor²,

Teacă³

2023

Gels

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Bile acid sequestrants (BASs) are non-systemic therapeutic agents used for the management of hypercholesterolemia. They are generally safe and not associated with serious systemic adverse effects. Usually, BASs are cationic polymeric gels that have the ability to bind bile salts in the small intestine and eliminate them by excretion of the non-absorbable polymer–bile salt complex. This review gives a general presentation of bile acids and the characteristics and mechanisms of action of BASs. The chemical structures and methods of synthesis are shown for commercial BASs of first- (cholestyramine, colextran, and colestipol) and second-generation (colesevelam and colestilan) and potential BASs. The latter are based on either synthetic polymers such as poly((meth)acrylates/acrylamides), poly(alkylamines), poly(allylamines) and vinyl benzyl amino polymers or biopolymers, such as cellulose, dextran, pullulan, methylan, and poly(cyclodextrins). A separate section is dedicated to molecular imprinting polymers (MIPs) because of their great selectivity and affinity for the template molecules used in the imprinting technique. Focus is given to the understanding of the relationships between the chemical structure of these cross-linked polymers and their potential to bind bile salts. The synthetic pathways used in obtaining BASs and their in vitro and in vivo hypolipidemic activities are also introduced.

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Section: Lipid-lowering Drugsmentioning

confidence: 99%

Bile Acid Sequestrants Based on Natural and Synthetic Gels

Stanciu¹,

Nichifor²,

Teacă³

2023

Gels

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“…Bismuth subsalicylate can be used; however, longterm use is not recommended due to neurotoxic effects [26]. Bile acid binding agents such as cholestyramine can also be used, as bile acid diarrhea often coexists with microscopic colitis [27], and openlabel trials have demonstrated a high response rate with Cholestyramine, with less budesonide dependence [28,29].…”

Section: Managementmentioning

confidence: 99%

The colitis may be microscopic, but the diarrhea is not: update on the treatment of microscopic colitis and immune checkpoint inhibitor colitis

Enwerem,

Yen

2023

Current Opinion in Gastroenterology

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Purpose of review Microscopic colitis is an inflammatory disease of the colon that presents as watery diarrhea with minimal to normal endoscopic changes on colonoscopy. It encompasses two common subtypes, lymphocytic colitis and collagenous colitis, which are both treated similarly. Immune checkpoint inhibitor colitis is among the most common immune-related adverse events. Endoscopic and histological findings range from normal colonic mucosa to inflammatory bowel like changes. This review article provides update in treatment and management of microscopic colitis and immune checkpoint inhibitor colitis (ICPi colitis). Recent findings Recent studies on microscopic colitis have focused on the successful use of immunomodulators such as biologics for treatment of budesonide refractory microscopic colitis cases. Microscopic colitis does not confer an added risk for colorectal cancer. With the increasing usage of immunotherapy agents, immune checkpoint inhibitor colitis is becoming more common. ICPi colitis can be successfully managed with steroids, with treatment stepped up to biologics for moderate to severe cases or for mild cases that do not respond to steroids. Immunotherapy agents can be carefully re-introduced in mild cases, after treatment of ICPi colitis. Summary Biologics can be used to treat budesonide refractory microscopic colitis. ICPi colitis can be managed with steroids and biologics in moderate to severe cases.

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“…Northcutt analyzed the effect of bile acid sequestrant therapy in seventy-nine patients with microscopic colitis following a registry in United States [ 48 ]. Forty-six of these seventy-nine patients (58.2%) had a response to this therapy.…”

Section: Pathogenesis Of Microscopic Colitismentioning

confidence: 99%

Microscopic Colitis: Pathogenesis and Diagnosis

Songtanin

Chen

Nugent

2023

JCM

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Microscopic colitis is a type of inflammatory bowel disease and is classified as either collagenous colitis or lymphocytic colitis. The typical presentation is chronic watery diarrhea. The disease occurs more frequently in women aged 60–65 years and is increasing in incidence. The pathophysiology of microscopic colitis remains poorly understood and has not been well-described with possible several pathogeneses. To date, the diagnosis of microscopic colitis depends on histological tissue obtained during colonoscopy. Other non-invasive biomarkers, such as inflammatory markers and fecal biomarkers, have been studied in microscopic colitis, but the results remains inconclusive. The approach to chronic diarrhea is important and being able to differentiate chronic diarrhea in patients with microscopic colitis from other diseases, such as inflammatory bowel disease, functional diarrhea, and malignancy, by using non-invasive biomarkers would facilitate patient management. The management of microscopic colitis should be based on each individual’s underlying pathogenesis and involves budesonide, bile acid sequestrants, or immunosuppressive drugs in refractory cases. Cigarette smoking and certain medications, especially proton pump inhibitors, should be eliminated, when possible, after the diagnosis is made.

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Bile Acid Sequestrant Therapy in Microscopic Colitis

Cited by 13 publications

References 32 publications

Bile Acid Sequestrants Based on Natural and Synthetic Gels

Bile Acid Sequestrants Based on Natural and Synthetic Gels

The colitis may be microscopic, but the diarrhea is not: update on the treatment of microscopic colitis and immune checkpoint inhibitor colitis

Microscopic Colitis: Pathogenesis and Diagnosis

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