PTU-128 The efficacy of using low-fat dietary interventions to manage bile acid malabsorption

Jackson, A. H.; Lalji, Amyn; Mohammed, Kabir; Muls, Ann; Gee, Caroline; Vyoral, Susan; Shaw, Christian Charles; Andreyev, Jervoise

doi:10.1136/gutjnl-2017-314472.223

Cited by 2 publications

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“…Dietary Modifications-A low fat diet with <20% of total daily caloric intake complements efficacy of bile acid sequestrant treatment in the relief of abdominal discomfort, distension, urgency, and stool consistency and frequency (63).…”

Section: Treatment Of Bammentioning

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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Section: Treatment Of Bammentioning

confidence: 99%

The Role of Bile Acids in Chronic Diarrhea

Camilleri

Vijayvargiya

2020

Am J Gastroenterol

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“…Dietary modifications : A diet with <20% of total daily caloric intake as fat complements efficacy of BA sequestrants in relief of abdominal discomfort, distension, urgency, and stool consistency and frequency 67 …”

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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PTU-128 The efficacy of using low-fat dietary interventions to manage bile acid malabsorption

Cited by 2 publications

References 0 publications

The Role of Bile Acids in Chronic Diarrhea

The Role of Bile Acids in Chronic Diarrhea

Bile Acid Diarrhea in Adults and Adolescents

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