Increased colonic bile acid exposure: a relevant factor for symptoms and treatment in IBS

Bajor, Antal; Törnblom, Hans; Rudling, Mats; Ung, Kjell-Arne; Simrén, Magnus

doi:10.1136/gutjnl-2013-305965

Cited by 186 publications

(189 citation statements)

References 67 publications

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“…Another limitation is that we did not assess symptom severity and its relationship with BAD, although a recent study has suggested that perceived symptom severity is not linked to 75 SeHCAT retention values. 17 Nevertheless, as a low 75 SeHCAT retention test value is characterised by having more frequent stools, and accelerated colonic transit time, future studies in patients presenting with D-IBS type symptoms may wish to explore whether quantifying stool frequency or consistency can be used as a predictive tool to diagnose idiopathic BAD.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, other studies have demonstrated a beneficial response to open treatment, particularly in those with moderate to severe BAD. 17,23 A systematic review noted that response to colestyramine occurred in 96% of patients with 75 SeHCAT retention <5%, 80% with 75 SeHCAT retention <10%, and 70% with 75 SeHCAT retention <15%. 23 In our study, of those that had BAD, 28.6% were mild, 28.6% moderate and 42.8% severe.…”

Section: Discussionmentioning

confidence: 99%

“…17 Furthermore, in those with BAD, open-label treatment with bile acid sequestrants led to a positive clinical response, thereby supporting the role of bile acids in IBS symptomatology. 17 However, this novel study used the Rome II criteria, which can show differences in agreement when sub-typing against the current Rome III criteria. 24 We now report our experience of testing for idiopathic BAD, using the…”

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confidence: 98%

“…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%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

mentioning

confidence: 99%

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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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“…Tiene el mismo mecanismo de acción que la colestiramina y es una alternativa para aquellos pacientes que no toleren dicha medicación, no es absorbido en la circulación sistémica por lo tanto no requiere ajuste en falla renal o enfermedad hepática crónica; en pacientes con síndrome de intestino irritable y mala-absorción de AB se ha demostrado una mejoría sintomática global superior al 50% evaluada entre la semana 5 y 8 de terapia (48,49)No se han realizados estudios del uso del colestipol como única terapia (47).…”

Section: -Colestipolunclassified

Diarrea pos colecistectomía, enfoque diagnóstico y terapéutico

Jaramillo¹,

S²,

Regino³

2017

Rev. Med.

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RESUMENLa colelitiasis es una enfermedad muy prevalente en la población general. El tratamiento de la colelitiasis, cuando se torna sintomática, es fundamentalmente quirúrgico. Una de sus complicaciones es la diarrea pos-colecistectomía que se define como la presencia de 3 o más deposiciones diarreicas por día por más de cuatro semanas en pacientes con el antecedente de colecistectomía, en ausencia de otra causa que explique la sintomatología. Debido a la incidencia reportada en la literatura alrededor del 15%, esta revisión presenta la epidemiologia, fisiopatología, diagnóstico, clasificación y tratamiento de esta patología. Adicionalmente se plantea una nueva clasificación de la patología que se correlacione con la fisiopatología.

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Diagnosis and Treatment of Irritable Bowel Syndrome

Camilleri

2021

JAMA

207

135

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ImportanceThe prevalence of irritable bowel syndrome (IBS) in the United States is between 7% and 16%, most common in women and young people, with annual direct costs estimated at more than $1 billion dollars in the United States. Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating. Several peripheral and central mechanisms initiate gastrointestinal motor and sensory dysfunctions leading to IBS symptoms. Those dysfunctions may require evaluation in patients whose symptoms do not respond to first-line treatments.ObservationsValidation studies of consensus symptom-based criteria have identified deficiencies that favor a simpler identification of the predominant symptoms of abdominal pain, bowel dysfunction, and bloating and exclusion of alarm symptoms such as unintentional weight loss, rectal bleeding, or recent change in bowel function. Symptom-based diagnosis of IBS is enhanced with additional history for symptoms of somatoform and psychological disorders and alarm symptoms, physical examination including digital rectal examination, and screening tests to exclude organic disease (by measuring hemoglobin and C-reactive protein concentrations). The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders. For patients who do not respond to those IBS treatments, testing for specific functional disorders may be required in a minority of patients with IBS. These disorders include rectal evacuation disorder, abnormal colonic transit, and bile acid diarrhea. Their identification is followed by individualized treatment, such as pelvic floor retraining for rectal evacuation disorders, sequestrants for bile acid diarrhea, and secretory agents for constipation, although there is only limited evidence that this individualized management approach is effective.Conclusions and RelevanceAdvances in the identification of specific dysfunctions as causes of individual symptoms in the “IBS spectrum” leads to the potential to enhance the diagnosis and management of symptoms for the majority of patients for whom first-line therapies of IBS and management of comorbid psychological disorders are insufficient.

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Increased colonic bile acid exposure: a relevant factor for symptoms and treatment in IBS

Abstract: Increased colonic bile acid exposure influences bowel habit and colonic transit time in patients with IBS. A high response rate to open label treatment with colestipol supports this, but placebo-controlled studies are warranted.

Cited by 186 publications

References 67 publications

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

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

Diarrea pos colecistectomía, enfoque diagnóstico y terapéutico

Diagnosis and Treatment of Irritable Bowel Syndrome

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