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

Vijayvargiya, Priya; Izundegui, Daniel Gonzalez; Calderón, Gerardo; Tawfic, Sarah; Batbold, Sarah; Saifuddin, Hiba; Duggan, P F; Melo, Valéria; Thomas, Taylor; Heeney, Megan; Beyde, Adrian; Miller, Janis M.; Valles, Kenneth; Oyemade, Kafayat A.; Brant, Joseph F.; Atieh, Jessica; Donato, Leslie J.; Camilleri, Michael

doi:10.1007/s10620-021-06993-5

Cited by 11 publications

(6 citation statements)

References 25 publications

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“…Prior studies have shown a higher prevalence of IBS-like symptoms in CD than in UC. 2 Although the mechanism for this has not been determined, we speculate that comorbid conditions in CD, such as SIBO 22 and bile acid malabsorption, 23 as well as possibly fibrostenotic disease may increase risk for IBS-like symptoms in CD relative to UC.…”

Section: Discussionmentioning

confidence: 97%

Predictors of irritable bowel syndrome‐like symptoms in quiescent inflammatory bowel disease

Ahmed,

Pu,

Jencks

et al. 2024

Neurogastroenterology Motil

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BackgroundMany patients with quiescent inflammatory bowel disease (IBD) suffer from irritable bowel syndrome (IBS)‐like symptoms. Although these symptoms cause significant reductions in quality of life, evidence‐based treatments are lacking as risk factors and pathophysiology of these symptoms are not clearly defined. We aimed to identify risk factors for development of IBS‐like symptoms in IBD patients with quiescent disease.MethodsWe performed a single‐center retrospective cohort study of adults with IBD from 2015 to 2021. Quiescent IBD was defined by a fecal calprotectin level <250 μg/g of stool or endoscopic evidence of quiescent disease. Cox regression was performed to identify variables that were independently associated with the incident development of IBS‐like symptoms in IBD patients.Key ResultsA total of 368 IBD patients were included for analysis, including 278 patients with UC and 88 with Crohn's disease. 15.5% of quiescent IBD patients developed IBS symptoms, with an incidence rate of (95% CI 48.0–82.0) 63.3 per 1000 person‐years. In the multivariate model, mood disorders (including anxiety and depression) and Crohn's disease were associated with increased risk for developing IBS symptoms. Male sex and higher iron levels conferred lower risk for developing IBS symptoms. Results from the multivariable model were similar in sensitivity analysis with quiescent IBD defined by fecal calprotectin level <150 mcg/g.Conclusions & InferencesMood disorder and Crohn's disease were positively associated with IBS‐like symptoms in quiescent IBD, whereas male sex and iron levels were protective. Our results were robust to different fecal calprotectin levels, arguing against inflammation as a mechanism for IBS‐like symptoms. This data suggests noninflammatory mechanisms may be important in the pathogenesis of IBS‐like symptoms in quiescent IBD. Future work may address whether modifying these risk factors may alter disease course.

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Section: Discussionmentioning

confidence: 97%

Predictors of irritable bowel syndrome‐like symptoms in quiescent inflammatory bowel disease

Ahmed,

Pu,

Jencks

et al. 2024

Neurogastroenterology Motil

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“…Moreover, some studies used different criteria to diagnose BAM: in the two case reports the response to a trial of cholestyramine was considered diagnostic for BAM [ 18 , 21 ]. One study used both SeHCAT test and C4 plasma concentrations > 20 ng/mL [ 26 ]; two others used C4 serum levels [ 28 , 30 ]; one used total fecal bile acid and primary fecal bile acid levels [ 31 ].…”

Section: Bile Acid Diarrhea and Microscopic Colitis In The Current Li...mentioning

confidence: 99%

“…In almost all studies, patients with MC and BAM were treated with cholestyramine, with a percentage of responders ranging from 70 to 80% (just one study showed a lower efficacy [ 22 ]). Bajor et al [ 26 ] and Vijayvargiya et al [ 31 ] treated patients with budesonide, with clinical benefits. Furthermore, the case report of Rampton et al revealed an improvement in histologic findings of rectal biopsies after treatment with cholestyramine [ 18 ].…”

Section: Bile Acid Diarrhea and Microscopic Colitis In The Current Li...mentioning

confidence: 99%

Misinterpreting Diarrhea-Predominant Irritable Bowel Syndrome and Functional Diarrhea: Pathophysiological Highlights

Sciumè,

Berti,

Lambiase

et al. 2023

JCM

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Irritable bowel syndrome with predominant diarrhea (IBS-D) and functional diarrhea (FD) are disorders of gut–brain interaction characterized by recurring symptoms which have a serious impact on the patient’s quality of life. Their pathophysiology is far from being completely understood. In IBS-D growing evidence suggests that bile acid malabsorption (BAM) could be present in up to 30% of patients. Microscopic colitis (MC) is a well-known cause of watery diarrhea and some patients, at first, can be diagnosed as IBS-D or FD. Both BAM and MC are often responsible for the lack of response to conventional treatments in patients labelled as “refractory”. Moreover, because BAM and MC are not mutually exclusive, and can be found in the same patient, they should always be considered in the diagnostic workout when a specific treatment for BAM or MC is unsatisfactory. In the present review the possible shared pathogenetic mechanisms between BAM and MC are discussed highlighting how MC can induce a secondary BAM. Moreover, a brief overview of the current literature regarding the prevalence of their association is provided.

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“…d. Diverse intestinal inflammatory diseases in remission: A study of 47% of 51patients with celiac disease in remission, 53% of 34 patients with collagenous colitis in remission, and 50% of 32 with lymphocytic colitis in remission showed patients had increased fecal BA excretion 59 …”

Section: Introductionmentioning

confidence: 99%

Bile Acid Diarrhea in Adults and Adolescents

Camilleri

Nurko

2021

Neurogastroenterology Motil

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Background Bile acids are central to enterohepatic signaling pathways activated through natural receptors, farnesoid X receptor [FXR mediates synthesis of fibroblast growth factor‐19 (FGF‐19)], and G protein‐coupled bile acid receptor 1 (GPBAR1, also known as TGR5). Although bile acid diarrhea (BAD) is more commonly encountered in ileal resection or disease, there is evidence documenting “idiopathic” BAD in about 20% of adolescents and 30% of adults presenting with chronic, non‐bloody diarrhea often attributed to irritable bowel syndrome. Mechanism(s) leading to increased hepatic synthesis and colonic bile acid levels in “idiopathic” BAD include reduced synthesis of FGF‐19 by the ileal mucosa, or genetic variation in hepatocyte proteins klotho β and FGF receptor 4 (FGFR4) that mediate negative feedback of bile acid synthesis. Purpose: The objective of this review is to summarize the diagnosis of BAD in adults and adolescents. In addition to 75SeHCAT retention for diagnosis of BAD, studies have validated fasting serum 7αC4 and FGF‐19, respectively, by‐product and inhibitor of hepatic bile acid synthesis, as well as fecal bile acid measurements. These assays are widely available through reference laboratories, and they are being simplified (eg, measurement of primary fecal bile acids in a random stool sample). BAD has also been identified as a co‐factor contributing to persistent diarrhea in other diseases in remission including inflammatory bowel disease, microscopic colitis, celiac disease, and neuroendocrine tumors. In summary, advances in diagnosis of BAD provide opportunities for generalists and pediatric and adult gastroenterologists to provide targeted treatment for BAD presenting as chronic non‐bloody diarrhea.

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

Cited by 11 publications

References 25 publications

Predictors of irritable bowel syndrome‐like symptoms in quiescent inflammatory bowel disease

Predictors of irritable bowel syndrome‐like symptoms in quiescent inflammatory bowel disease

Misinterpreting Diarrhea-Predominant Irritable Bowel Syndrome and Functional Diarrhea: Pathophysiological Highlights

Bile Acid Diarrhea in Adults and Adolescents

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