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Update on Bile Acid Malabsorption: Finally Ready for Prime Time?

  • Large Intestine (B Cash, Section Editor)
  • Published:
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Abstract

Purpose of Review

To provide an update on the prevalence, pathophysiology, disease associations, and treatment options for bile acid malabsorption (BAM).

Recent Findings

•Molecular mechanisms—BAs prevent water reabsorption and increase water secretion by intracellular mediators, increasing aquaporin channels and intracellular permeability. •Inflammatory bowel disease—new molecular mechanisms of BAM are identified in patients without ileal disease, including changes in expression of ileal BA transporter and nuclear receptors involved in BA homeostasis. •Microscopic colitis—BAM is one of the mechanisms leading to microscopic colitis. •Diagnostic testing—new diagnostic tests have been launched in the USA (serum C4 and fecal 48-h BA excretion); stimulated FGF19 has higher detection of BAM compared to fasting sample alone. •Treatment—investigational FXR agonists may provide a daily, oral option for treatment of BAM instead of BA sequestrants.

Summary

There is a greater appreciation of the biological role of bile acids across multiple fields of medicine, including gastrointestinal indications.

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Abbreviations

ASBT:

Apical sodium bile acid transporter

BA:

Bile acid

BAM:

Bile acid malabsorption

BAS:

Bile acid sequestrants

C4:

7 α-hydroxy-4-cholesten-3-one

CA:

Cholic acid

CDCA:

Chenodeoxycholic acid

DCA:

Deoxycholic acid

FGF19:

Fibroblast growth factor 19

FXR:

Farsenoid X receptor

GPBAR1/TGR5:

G protein coupled bile receptor 1

HAPC:

High amplitude propagating contractions

IBS:

C—constipation predominanat irritable bowel syndrome

IBS:

D—diarrhea predominant irritable bowel syndrome

IBD:

Inflammatory bowel disease

LCA:

Lithocholic acid

PXR:

Pregane X receptor

75SeHCAT:

75Selenium homotaurocholic acid test

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Vijayvargiya, P., Camilleri, M. Update on Bile Acid Malabsorption: Finally Ready for Prime Time?. Curr Gastroenterol Rep 20, 10 (2018). https://doi.org/10.1007/s11894-018-0615-z

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