Chronic diarrhea caused by idiopathic bile acid malabsorption: an explanation at last

Hofmann, Alan F.

doi:10.1586/egh.09.49

Cited by 25 publications

(22 citation statements)

References 38 publications

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“…19 The concentration of bile in the gallbladder is achieved by isotonic reabsorption of NaCl and NaHCO 3 alongside 90% of the water content. 22 Most of the reabsorbed bile acids are eventually taken up by and undergo reconjugation in the liver. 22 Most of the reabsorbed bile acids are eventually taken up by and undergo reconjugation in the liver.…”

Section: Bile Acidsmentioning

confidence: 99%

“…21 After a meal and nutrient stim- Less than 5% of the bile acids are not reabsorbed from the intestinal lumen during each cycle and are excreted in the faeces. 19 The total bile acid pool in the body can be measured by isotope dilution, and comprises about 3 g. 22 The physiology of bile acids has traditionally revolved around its contribution to the assimilation of fat and fat-soluble vitamins. This recirculation of bile acids between the small intestine and the liver is denominated the enterohepatic cycling of bile acids, which has been reviewed in detail elsewhere.…”

Section: Bile Acidsmentioning

confidence: 99%

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Evidence connecting old, new and neglected glucose‐lowering drugs to bile acid‐induced GLP‐1 secretion: A review

Kårhus

Brønden

Sonne

et al. 2017

Diabetes Obesity Metabolism

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Bile acids are amphipathic water-soluble steroid-based molecules best known for their important lipid-solubilizing role in the assimilation of fat. Recently, bile acids have emerged as metabolic integrators with glucose-lowering potential. Among a variety of gluco-metabolic effects, bile acids have been demonstrated to modulate the secretion of the gut-derived incretin hormone glucagon-like peptide-1 (GLP-1), possibly via the transmembrane receptor Takeda G-protein-coupled receptor 5 and the nuclear farnesoid X receptor, in intestinal L cells. The present article critically reviews current evidence connecting established glucose-lowering drugs to bile acid-induced GLP-1 secretion, and discusses whether bile acid-induced GLP-1 secretion may constitute a new basis for understanding how metformin, inhibitors of the apical sodium-dependent bile acids transporter, and bile acid sequestrants - old, new and neglected glucose-lowering drugs - improve glucose metabolism.

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Section: Bile Acidsmentioning

confidence: 99%

Section: Bile Acidsmentioning

confidence: 99%

Evidence connecting old, new and neglected glucose‐lowering drugs to bile acid‐induced GLP‐1 secretion: A review

Kårhus

Brønden

Sonne

et al. 2017

Diabetes Obesity Metabolism

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show abstract

“…A massive efflux in the intestinal lumen, as occurs in bile acid malabsorption (BAM), causes diarrhea. Bile acid malabsorption may be diagnosed in 30–50% of patients with chronic idiopathic diarrhea 19–22 . A recent and original therapeutic approach for patients with diarrhea‐predominant IBS (IBS‐D) has been proposed based on the BA sequestrant, colesevelam, 12 which enhances the ease of passage of stool.…”

Section: Introductionmentioning

confidence: 99%

Increase in fecal primary bile acids and dysbiosis in patients with diarrhea‐predominant irritable bowel syndrome

Duboc

Rainteau

Rajca

et al. 2012

Neurogastroenterology Motil

203

164

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We report an increase of primary BA in the feces of IBS-D patients compared to HS, correlated with stool consistency and frequency. A dysbiosis of different bacterial groups was detected, some of them involved in BA transformation. As the gut microbiota is the exclusive pathway to transform primary into secondary BA, this suggests a functional consequence of dysbiosis, leading to lower BA transformation.

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“…Th e authors appropriately recommend the need for replication of their fi ndings in larger numbers of patients; however, they are to be congratulated for following through on their original observation, which Alan Hofmann heralded as "an explanation at last" for chronic diarrhea caused by ileal BA malabsorption ( 9 ). It is also gratifying that associations between FGFR4 and KLB genes and the endophenotype of 75 SeHCAT retention confi rm the previously described associations of precisely the same, functionally signifi cant, genetic polymorphisms with rapid colonic transit ( 6 ).…”

Section: Ibabp (Which Would Reduce the Concentration Of Intracellularmentioning

confidence: 99%

Editorial: Dissecting Molecular Mechanisms in Bile Acid Diarrhea

Camilleri

2016

American Journal of Gastroenterology

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It was previously demonstrated that patients with bile acid (BA) diarrhea have low fasting serum levels of the ileal hormone--fibroblast growth factor-19 (FGF-19). In this paper, the authors demonstrate a positive correlation between ileal transcripts of FGF-19 and (75)SeHCAT retention, providing further evidence of FGF-19 deficiency as an explanation for BA diarrhea. Variants in KLB and FGFR4 genes (that determine the functional re-uptake of BA in the portal circulation by hepatocytes) are also demonstrated to be associated with (75)SeHCAT retention, confirming a second potential mechanism for the development of BA diarrhea.

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Chronic diarrhea caused by idiopathic bile acid malabsorption: an explanation at last

Cited by 25 publications

References 38 publications

Evidence connecting old, new and neglected glucose‐lowering drugs to bile acid‐induced GLP‐1 secretion: A review

Evidence connecting old, new and neglected glucose‐lowering drugs to bile acid‐induced GLP‐1 secretion: A review

Increase in fecal primary bile acids and dysbiosis in patients with diarrhea‐predominant irritable bowel syndrome

Editorial: Dissecting Molecular Mechanisms in Bile Acid Diarrhea

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