Diagnosis of bile acid diarrhoea by fasting and postprandial measurements of fibroblast growth factor 19

Borup, Christian; Syversen, Charlotte; Bouchelouche, Pierre; Damgaard, Morten; Graff, Jesper; Rumessen, Jüri Johannes; Munck, Lars Kristian

doi:10.1097/meg.0000000000000476

Cited by 19 publications

(15 citation statements)

References 19 publications

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“…Key evidence. The majority of published DTAs compared C4 [46][47][48] and FGF19 32,49,50 assays with SeHCAT testing. These showed good inverse correlation between C4 and SeHCAT testing, and between FGF19 and SeHCAT testing, however, the overall CoE for the diagnostic accuracy of SeHCAT was assessed for Statement 3 and determined to be very low.…”

Section: Gradementioning

confidence: 99%

Canadian Association of Gastroenterology Clinical Practice Guideline on the Management of Bile Acid Diarrhea

Sadowski

Camilleri

Chey

et al. 2020

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS: Chronic diarrhea affects about 5% of the population overall. Altered bile acid metabolism is a common but frequently undiagnosed cause. METHODS: We performed a systematic search of publication databases for studies of assessment and management of bile acid diarrhea (BAD). The certainty (quality) of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation approach. Patient population, intervention, comparator, and outcome questions were developed through an iterative process and were voted on by a group of specialists. RESULTS: The certainty of evidence was generally rated as very low. Therefore, 16 of 17 recommendations are conditional. In patients with chronic diarrhea, consideration of risk factors (terminal ileal resection, cholecystectomy, or abdominal radiotherapy), but not additional symptoms, was recommended for identification of patients with possible BAD. The group suggested testing using 75 selenium homocholic acid taurine (where available) or 7a-hydroxy-4-cholesten-3-one, including patients with irritable bowel syndrome with diarrhea, functional diarrhea, and Crohn's disease without inflammation. Testing was suggested over empiric bile acid sequestrant therapy (BAST). Once remediable causes are managed, the group suggested cholestyramine as initial therapy, with alternate BAST when tolerability is an issue. The group suggested against BAST for patients with extensive ileal Crohn's disease or resection and suggested alternative antidiarrheal agents if BAST is not tolerated. Maintenance BAST should be given at the lowest effective dose, with a trial of intermittent, on-demand administration, concurrent medication review, and reinvestigation for patients whose symptoms persist despite BAST. CONCLUSIONS: Based on a systematic review, BAD should be considered for patients with chronic diarrhea. For patients with positive results from tests for BAD, a trial of BAST, initially with cholestyramine, is suggested.

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Section: Gradementioning

confidence: 99%

Canadian Association of Gastroenterology Clinical Practice Guideline on the Management of Bile Acid Diarrhea

Sadowski

Camilleri

Chey

et al. 2020

Clinical Gastroenterology and Hepatology

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“…Therefore, fasting serum FGF-19 would appear to be most helpful to rule out BAM, if and when it becomes available for use in clinical practice. Further research is required to assess a modification on the test, which is CDCA-stimulated FGF-19 (acting as a "stress test") in the diagnosis of BAD (56). Recent guideline did not recommend the test as a first line diagnostic test for BAD (57).…”

Section: Serum Fasting Fibroblast Growth Factor 19 (Fgf-19)mentioning

confidence: 99%

The Role of Bile Acids in Chronic Diarrhea

Camilleri

Vijayvargiya

2020

Am J Gastroenterol

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Bile acids are central signals in enterohepatic communication and they also integrate microbiotaderived signals into enterohepatic signaling. The tissue distribution and signaling pathways activated by bile acids through natural receptors, farnesoid X receptor and G protein-coupled bile acid receptor 1 (GPBAR1, also known as TGR5), have led to greater understanding of mechanisms and potential therapeutic agents. Bile acid diarrhea is most commonly encountered in ileal resection or disease, in idiopathic disorders (with presentation similar to functional diarrhea or irritable bowel syndrome with diarrhea), and in association with malabsorption such as chronic pancreatitis or celiac disease. Diagnosis of bile acid diarrhea is based on 75 SeHCAT retention, or 48 hour fecal bile acid excretion, or serum 7αC4; the latter being a marker of hepatic bile acid synthesis. Bile acid diarrhea tends to be associated with higher BMI, increased stool weight and stool fat, and acceleration of colonic transit. Biochemical markers of increased bile acid synthesis or excretion are available through reference laboratories. Current treatment of bile acid diarrhea is based on bile acid sequestrants, and, in the future, it is anticipated that FXR receptor agonists may also be effective. The optimal conditions for an empiric trial with bile acid sequestrants as a diagnostic test are still unclear. However, such therapeutic trials are widely used in clinical practice. Some national guidelines recommend definitive diagnosis of bile acid diarrhea over empirical trial.

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“…Patients with bile acid diarrhoea have median fasting levels of C4 which are raised, with FGF19 being reduced . These findings have been confirmed by several groups but in all these studies, the individual variability in fasting FGF19 reduced the performance of a single measurement as a diagnostic test.…”

mentioning

confidence: 64%

Editorial: developing a stimulation test to identify FGF19 deficiency in bile acid diarrhoea

Walters

2017

Aliment Pharmacol Ther

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Diagnosis of bile acid diarrhoea by fasting and postprandial measurements of fibroblast growth factor 19

Cited by 19 publications

References 19 publications

Canadian Association of Gastroenterology Clinical Practice Guideline on the Management of Bile Acid Diarrhea

Canadian Association of Gastroenterology Clinical Practice Guideline on the Management of Bile Acid Diarrhea

The Role of Bile Acids in Chronic Diarrhea

Editorial: developing a stimulation test to identify FGF19 deficiency in bile acid diarrhoea

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