Fibroblast growth factor 19 in patients with bile acid diarrhoea: a prospective comparison of FGF19 serum assay and SeHCAT retention

Pattni, Sanjeev S.; Brydon, W. G.; Dew, Tracy; Johnston, Ian; Nolan, Jonathan; Srinivas, M.; Basumani, Pandurangan; Bardhan, Karna Dev; Walters, Julian R.F.

doi:10.1111/apt.12466

Cited by 101 publications

(114 citation statements)

References 35 publications

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“…8,[13][14][15][16][17] Measuring serum 7-alpha-hydroxy-4-cholestene-3-one or fi broblast growth factor 19 (FGF-19) levels are alternative tests but are currently only available for research purposes in the UK. [18][19][20][21][22][23][24] Colestyramine, the most commonly used BAS believed to reduce symptoms, is poorly tolerated due to its unpleasant texture and side effects, including nausea, bloating, fl atulence and abdominal pain. 8,10,12,25 Consequently, over half of people started on colestyramine discontinue the medication within a year, often sooner.…”

Section: Introductionmentioning

confidence: 99%

Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy

et al. 2015

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Although recognised as a cause of chronic diarrhoea for over forty years, diagnostic tests and treatments for bile acid malabsorption (BAM) remain controversial. Recent National Institute for Health and Care Excellence (NICE) guidelines highlighted the lack of evidence in the fi eld, and called for further research. This retrospective study explores the BAM subtype and severity, the use and response to bile acid sequestrants (BAS) and the prevalence of abnormal colonic histology. 264 selenium-75-labelled homocholic acid conjugated taurine (SeHCAT)-tested patient records were reviewed and the severity and subtype of BAM, presence of colonic histopathology and response to BAS were recorded. 53% of patients tested had BAM, with type-2 BAM in 45% of patients with presumed irritable bowel syndrome. Colonic histological abnormalities were similar overall between patients with (29%) or without (23%) BAM (p=0.46) and between BAM subtypes, with no signifi cant presence of infl ammatory changes. 63% of patients with BAM had a successful BAS response which showed a trend to decreased response with reduced severity. Colestyramine was unsuccessful in 44% (38/87) and 45% of these (17/38) were related to medication intolerance, despite a positive SeHCAT. 47% (7/15) of colestyramine failures had a successful colesevelam response. No patient reported colesevelam intolerance. Quantifying severity of BAM appears to be useful in predicting BAS response. Colesevelam was better tolerated than colestyramine and showed some effi cacy in colestyramine failures. Colestyramine failure should not be used to exclude BAM. Colonic histology is of no relevance.

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Section: Introductionmentioning

confidence: 99%

Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy

et al. 2015

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“…Improved methods to diagnose bile acid malabsorption are needed, and the fibroblast growth factor 19 assay based on a simple, inexpensive commercial ELISA holds promise as a serological test compared with exposure to radiation scanning with selenium homocholic acid taurine [23,24].…”

Section: Organic Disease and Fgid Symptomsmentioning

confidence: 99%

Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology

2015

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Functional gastrointestinal disorders (FGIDs) are common and distressing. They are so named because a defined pathophysiology in terms of structural or biochemical pathways is lacking. Traditionally FGIDs have been conceptualized as brain-gut disorders, with subgroups of patients demonstrating visceral hypersensitivity and motility abnormalities as well as psychological distress. However, it is becoming apparent that there are certain structural or biochemical gut alterations among subsets with the common FGIDs, most notably functional dyspepsia (FD) and irritable bowel syndrome (IBS). For example, a sodium channel mutation has been identified in IBS that may account for 2 % of cases, and subtle intestinal inflammation has been observed in both IBS and FD. Other research has implicated early life events and stress, autoimmune disorders and atopy and infections, the gut microbiome and disordered mucosal immune activation in patients with IBS or FD. Understanding the origin of symptoms in FGIDs will allow therapy to be targeted at the pathophysiological changes, not at merely alleviating symptoms, and holds hope for eventual cure in some cases.For example, there are promising developments in manipulating the microbiome through diet, prebiotics and antibiotics in IBS, and testing and treating patients for Helicobacter pylori infection remains a mainstay of therapy in patients with dyspepsia and this infection. Locally acting drugs such as linaclotide have been an advance in treating the symptoms of constipation-predominant IBS, but do not alter the natural history of the disease. A role for a holistic approach to patients with FGIDs is warranted, as brain-togut and gut-to-brain pathways appear to be activated.

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“…17 However, in the current climate, as none of these tests are routinely available in countries such as the USA, there is interest in the development of a simple, cheap, and readily available biomarker that will help screen for patients that potentially have BAD who can then subsequently be referred on for confirmatory tests. Of these, measurement of serum FGF-19, 18 identification of the primary bile acids cholate and chenodeoxycholate in a single stool sample, 19,20 or detection of volatile organic compounds in a single urine sample (presumed to be a consequence of dysbiosis secondary to elevated levels of colonic bile acids), 21 have all shown initial promising results, but require further work to validate their clinical applicability.…”

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confidence: 99%

High Prevalence of Idiopathic Bile Acid Diarrhea Among Patients With Diarrhea-Predominant Irritable Bowel Syndrome Based on Rome III Criteria

Aziz

Mumtaz

Bholah

et al. 2015

Clinical Gastroenterology and Hepatology

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Abstract:Background & Aims: Some studies have found that patients with idiopathic bile acid diarrhea (BAD) present with symptoms of diarrhea-predominant irritable bowel syndrome (D-IBS). However, these studies were either retrospective, did not define D-IBS according to current criteria, or included patients with chronic functional diarrhea. We performed a prospective study of the prevalence of idiopathic BAD in consecutive patients fulfilling the Rome III criteria for D-IBS. Methods:We analyzed data from 118 consecutive adult patients who fulfilled the Rome III criteria for D-IBS (mean age, 41.7 years; 72.9% female), seen at 2 gastroenterology clinics in the UK. We excluded patients with risk factors for BAD (previous history of cholecystectomy, terminal ileal C celiac disease, or microscopic colitis). Participants completed questionnaires at baseline (on demographics, hospital anxiety, somatization, and depression, as well as the patient health questionnaire-12 and the short form-36 [SF-36]), and then received the 75 selenium homocholic acid taurine retention test. Retention of 75 selenium homocholic acid taurine 7 days after administration BAD BAD BAD BAD Results: Twenty-eight were found to have BAD (23.7% of total), with similar percentages at each study site (25.3% and 20%; P=.54). Eight patients had mild BAD (28.6%), 8 had moderate BAD (28.6%), and 12 had severe BAD (42.8%). There was no statistical difference in age or sex, or depression, patient health questionnaire-12, or SF-36 scores, between individuals with vs without BAD. However, patients with BAD had a higher mean body mass index than those without BAD (31.6 vs. 26.4; P=.003). Physical activity (based on the SF-36) was significantly lower in subjects with moderate (43.8) or severe BAD (41.7), compared to patients with mild BAD (87.5) (P=.046). Conclusion:Almost 25% of patients presenting with D-IBS have idiopathic BAD; most cases are moderate to severe. Guidelines should advocate testing to exclude BAD before patients are diagnosed with D-IBS.

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Fibroblast growth factor 19 in patients with bile acid diarrhoea: a prospective comparison of FGF19 serum assay and SeHCAT retention

Cited by 101 publications

References 35 publications

Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy

Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy

Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology

High Prevalence of Idiopathic Bile Acid Diarrhea Among Patients With Diarrhea-Predominant Irritable Bowel Syndrome Based on Rome III Criteria

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