Document Detail

Defining primary bile acid diarrhea: making the diagnosis and recognizing the disorder.
MedLine Citation:
PMID:  20932141     Owner:  NLM     Status:  MEDLINE    
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.
Julian R F Walters
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Expert review of gastroenterology & hepatology     Volume:  4     ISSN:  1747-4132     ISO Abbreviation:  Expert Rev Gastroenterol Hepatol     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-11     Completed Date:  2011-01-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101278199     Medline TA:  Expert Rev Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  561-7     Citation Subset:  IM    
Section of Hepatology & Gastroenterology, Department of Medicine, Imperial College London and, Imperial College Healthcare, London, UK.
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MeSH Terms
Bile Acids and Salts / metabolism*
Biological Markers / blood
Cholestenones / blood
Chronic Disease
Diagnosis, Differential
Diarrhea / etiology*,  metabolism
Enterohepatic Circulation
Fibroblast Growth Factors / metabolism
Malabsorption Syndromes / complications,  diagnosis*,  metabolism
Predictive Value of Tests
Radiopharmaceuticals / diagnostic use
Taurocholic Acid / analogs & derivatives,  diagnostic use
Reg. No./Substance:
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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