| Defining primary bile acid diarrhea: making the diagnosis and recognizing the disorder. | |
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MedLine Citation:
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PMID: 20932141 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Chronic diarrhea due to bile acid malabsorption may be considered as contributing to the diagnosis when it results from secondary causes, such as ileal resection affecting the enterohepatic circulation. However, the primary form (also known as idiopathic bile acid malabsorption) is not well recognized as a common condition and patients are left undiagnosed. Primary bile acid diarrhea can be diagnosed by the nuclear medicine 75Se-homocholyltaurine (SeHCAT) test, although this is unavailable or underutilized in many settings. A systematic review suggests that approximately 30% of patients who would otherwise be diagnosed with diarrhea-predominant irritable bowel syndrome or functional diarrhea have abnormal SeHCAT retention. Serum 7α-hydroxy-4-cholesten-3-one can also be measured to show increased bile acid synthesis. The reasons for the lack of recognition of primary bile acid diarrhea are discussed, and these are compared with the other common cause of malabsorption, celiac disease. The lack of a clear pathophysiological mechanism has been a problem, but recent evidence suggests that impaired feedback control of hepatic bile acid synthesis by the ileal hormone FGF19 results in overproduction of bile acids. The identification of FGF19 as the central mechanism opens up new areas for development in the diagnosis and treatment of primary bile acid diarrhea. |
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Authors:
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Julian R F Walters |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Expert review of gastroenterology & hepatology Volume: 4 ISSN: 1747-4132 ISO Abbreviation: Expert Rev Gastroenterol Hepatol Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-10-11 Completed Date: 2011-01-21 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101278199 Medline TA: Expert Rev Gastroenterol Hepatol Country: England |
Other Details:
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Languages: eng Pagination: 561-7 Citation Subset: IM |
Affiliation:
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Section of Hepatology & Gastroenterology, Department of Medicine, Imperial College London and, Imperial College Healthcare, London, UK. julian.walters@imperial.ac.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Bile Acids and Salts
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metabolism* Biological Markers / blood Cholestenones / blood Chronic Disease Diagnosis, Differential Diarrhea / etiology*, metabolism Enterohepatic Circulation Fibroblast Growth Factors / metabolism Humans Malabsorption Syndromes / complications, diagnosis*, metabolism Predictive Value of Tests Prognosis Radiopharmaceuticals / diagnostic use Taurocholic Acid / analogs & derivatives, diagnostic use |
| Chemical | |
Reg. No./Substance:
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0/Bile Acids and Salts; 0/Biological Markers; 0/Cholestenones; 0/FGF19 protein, human; 0/Radiopharmaceuticals; 3862-25-7/7 alpha-hydroxy-4-cholesten-3-one; 62031-54-3/Fibroblast Growth Factors; 75018-70-1/23-seleno-25-homotaurocholic acid; 81-24-3/Taurocholic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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