Year 2019 / Volume 111 / Number 1
Original
Bile acid malabsorption in patients with chronic diarrhea and Crohn’s disease

40-45

DOI: 10.17235/reed.2018.5376/2017

Luisa M.ª Mena Bares, José M. Benítez Cantero, Eva Iglesias Flores, Beatriz Gros Alcalde, Estefanía Moreno Ortega, Francisco R. Maza Muret, Elvira Carmona Asenjo, M.ª Valle García Sánchez, Juan A. Vallejo Casas,

Abstract
Introduction and aim: Crohn’s disease (CD) is a form of inflammatory bowel disease and is mainly characterized by diarrhea and abdominal pain. The aim of our study was to analyze the usefulness of performing a 75SeHCAT scan in CD patients with chronic diarrhea and suspected bile acid malabsorption (BAM). In addition, we aimed to determine whether there was a relationship with the clinical features of the disease and a previous bowel resection. Patients and methods: this was an observational cross-sectional study of 39 patients with a diagnosis of CD and chronic diarrhea. All cases underwent a 75SeHCAT scan for BAM diagnosis, after discarding disease activity. Results: the study cohort included 19 females and 20 males. The median age was 44 years and the majority of patients were A2 L1 B1 according to the Montreal classification; 84.6% of patients had undergone a previous bowel resection. BAM was present in 97.4% of patients (100% and 83.3% of patients with and without previous surgery, respectively), which was severe in 92.1% of cases. Treatment with bile acid sequestrants was initiated and a favorable response was obtained in 72.2% of patients. The relationship between BAM degree (moderate or severe), bowel surgery and the response to bile acid sequestrant treatment was also analyzed but not statistically significant. Conclusion: BAM is a frequent cause of diarrhea in CD patients in endoscopic or radiological remission. This condition was present in all patients with a history of a bowel resection. A response to bile acid sequestrants treatment was observed in 73% of patients.
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08/08/2021 16:14:32
Excelente introducción


References
1.- Gassull MA, Gomollón F, Obrador A, et al. Enfermedad Inflamatoria Intestinal, 2.ª edición. Ergon. Madrid, 2002. p 209-18.
2.- Van Assche G, Dignass A, Panés J, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease. J Crohns Colitis 2010; 4: 7-27.
3.- Satsangi J, Silverberg MS, Vermeire S, et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 2006; 55:749-53.
4.- Schiller LR. Chronic Diarrhea. Gastroenterology 2004; 127: 287-93.
5.- Fine KD, Schiller LR. AGA technical review on the evaluation and management of chronic diarrhea. Gastroenterology 1999; 116: 1464-86.
6.- Camilleri M. Advances in understanding of bile acid diarrhea. Expert Rev Gastroenterol Hepatol 2014; 8: 49-61.
7.- Walters JR, Pattni SS. Managing bile acid diarrhoea. Therap Adv Gastroenterol 2010; 3: 349-57.
8.- Sciarretta G, Vicini G, Fagioli G, et al. Use of 23-selena-25-homocholyltaurine to detect bile acid malabsorption in patients with illeal dysfunction or diarrhea. Gastroenterology 1986; 91: 1-9.
9.- Pattni SS, Brydon WG, Dew T, et al. Fibroblast Growth Factor 19 and 7α-Hydroxy-4-Cholesten-3-one in the Diagnosis of Patients With Possible Bile Acid Diarrhea. Clin Transl Gastroenterol 2012; 3: e18.
10.- Wilcox C, Turner J, Green J. Systematic review: the management of chronic diarrhoea due to bile acid malabsorption. Aliment Pharmacol Ther 2014; 39: 923-39.
11.- Mena Bares LM, Carmona Asenjo E, García Sánchez MV, et al. Gammagrafía con 75SeHCAT en la diarrea crónica por malabsorción de ácidos biliares. Rev Esp Med Nucl Imagen Mol 2017; 36: 37-47.
12.- Thaysen EH, Orholm M, Arnfred T, Carl J, Rødbro P. Assessment of ileal function by abdominal counting of the retention of a gamma emitting bile acid analogue. Gut 1982; 23: 862-5.
13.- Merrick MV, Eastwood MA, Anderson JR, et al. Enterohepatic circulation in man of a gamma-emitting bile-acid conjugate, 23-selena-25-homotaurocholic acid (SeHCAT). J Nucl Med 1982; 23: 126-30.
14.- Soundy RG, Simpson JD, Ross HM, et al. Absorbed dose to man from the Se-75 labeled conjugated bile salt SeHCAT: concise communication. J Nucl Med 1982; 23: 157-61.
15.- Notghi A, O'Brien J, Low CS, et al. Measuring SeHCAT retention: a technical note. Nucl Med Commun 2011; 32: 960-6.
16.-Martín-Comín J, Bonnin D, Baliellas C, et al. Medición de la función ileal con 75Se-SeHCAT, utilizando una gammacámara colimada, en pacientes con enfermedad inflamatoria intestinal. Rev Esp Med Nuclear 1990; 9: 91-5.
17.- Notta PC, Ramal D, Maisterra S, et al. Medición de la absorción de los ácidos biliares en el diagnóstico inicial de la diarrea crónica. Rev Esp Med Nucl 2011; 30: 297-300.
18. Oostlander AE, Bravenboer N, Sohl E, et al. Histomorphometric analysis reveals reduced bone mass and bone formation in patients with quiescent Crohn’s disease. Gastroenterology 2011; 140: 116-23.
19. Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and emission in inflammatory bowel disease: a cohort study. Lancet 2010; 375: 657-63.
20.- Vantrappen Y, Ghoss Y, Rutgeerts P, et al. Bile acid studies in uncomplicated Crohn´s disease. Gut 1997; 18: 730-5.
21.- Poley JR, Hofmann AF. Role of fat maldigestion in pathogenesis of steatorrhea in ileal resection. Fat digestion after two sequential test meals with and without cholestyramine. Gastroenterology 1976; 71: 38-44.
22.- Ung KA, Olofsson G, Fae A, et al. In vitro determination of active bile acid absorption in small biopsy specimens obtained endoscopically or surgically from the human intestine. Eur J Clin Invest 2002; 32: 115-21.
23.- Mottacki N, Simrén M, Bajor A. Review article: bile acid diarrhoea - pathogenesis, diagnosis and management. Aliment Pharmacol Ther 2016; 43: 884-98.
24.- Kurien M, Evans KE, Leeds JS, et al. Bile acid malabsorption: an under-investigated differential diagnosis in patients presenting with diarrhea predominant irritable bowel syndrome type symptoms. Scand J Gastroenterol 2011; 46: 818-22.
25.- Borghede MK, Schlütter JM, Agnholt JS, et al. Bile acid malabsorption investigated by selenium-75-homocholic acid taurine ((75)SeHCAT) scans: causes and treatment responses to cholestyramine in 298 patients with chronic watery diarrhoea. Eur J Intern Med 2011; 22: e137-40.
26.- Neimark E, Chen F, Li X, et al. c-Fos is a critical mediator of inflammatory-mediated repression of the apical sodium-dependent bile acid transporter. Gastroenterology 2006; 131: 554-67.
27.- Chen F, Ma L, Sartor RB, et al. Inflammatory-mediated repression of the rat ileal sodium-dependent bile acid transporter by c-fos nuclear translocation. Gastroenterology 2002; 123: 2005-16.
28.- Gadaleta RM, Oldenburg B, Willemsen EC, et al. Activation of bile salt nuclear receptor FXR is repressed by pro-inflammatory cytokines activating NF-κB signaling in the intestine. Biochim Biophys Acta 2011; 1812: 851-8.
29.- Fernández-Bañares F, Rosinach M, Piqueras M, et al. Randomised clinical trial: colestyramine vs. hydroxypropyl cellulose in patients with functional chronic watery diarrhoea. Aliment Pharmacol Ther 2015; 41: 1132-40.
30.- Orekoya O, McLaughlin J, Leitao E, et al. Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy. Clin Med (Lond) 2015; 15: 252-7.
31.- Beigel F, Teich N, Howaldt S, et al. Colesevelam for the treatment of bile acid malabsorption-associated diarrhea in patients with Crohn's disease: a randomized, double-blind, placebo-controlled study. J Crohns Colitis 2014; 8: 1471-9.
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Mena Bares L, Benítez Cantero J, Iglesias Flores E, Gros Alcalde B, Moreno Ortega E, Maza Muret F, et all. Bile acid malabsorption in patients with chronic diarrhea and Crohn’s disease. 5376/2017


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Publication history

Received: 14/11/2017

Accepted: 10/07/2018

Online First: 04/10/2018

Published: 17/01/2019

Article revision time: 231 days

Article Online First time: 324 days

Article editing time: 429 days


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