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中华结直肠疾病电子杂志 ›› 2022, Vol. 11 ›› Issue (05) : 425 -428. doi: 10.3877/cma.j.issn.2095-3224.2022.05.012

综述

胆汁酸性腹泻的发生机制与诊断
毛宁1, 朱勇1,()   
  1. 1. 210012 南京中医药大学附属南京中医院肛肠科
  • 收稿日期:2021-12-28 出版日期:2022-10-25
  • 通信作者: 朱勇
  • 基金资助:
    南京市医学科技发展项目(YKK17151); 南京市卫生青年人才项目(QRX17902); 南京市中医药转化医学项目(ZHZD201801)

Pathogenesis and diagnosis of bile acid diarrhea

Ning Mao1, Yong Zhu1,()   

  1. 1. Department of Colorectal Surgery, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210012, China
  • Received:2021-12-28 Published:2022-10-25
  • Corresponding author: Yong Zhu
引用本文:

毛宁, 朱勇. 胆汁酸性腹泻的发生机制与诊断[J]. 中华结直肠疾病电子杂志, 2022, 11(05): 425-428.

Ning Mao, Yong Zhu. Pathogenesis and diagnosis of bile acid diarrhea[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(05): 425-428.

胆汁酸性腹泻(BAD)是慢性腹泻的常见病因,发病率较高但多被漏诊。近年来欧美国家对于该疾病关注度逐渐提高,但国内对此仍知之甚少,本文介绍了BAD发生的机制与国际上BAD常用的诊断方式,并对各种方式的优缺点进行探讨。

Bile acid diarrhea (BAD) is a common cause of chronic diarrhea, with a high incidence rate but missed diagnosis. In recent years, the attention of European and American countries has gradually increased. However, little is known about it in China. This article introduces the mechanism of BAD and the common diagnostic methods of BAD in the world, and discusses the advantages and disadvantages of various methods.

表1 BAD的常见病因
[1]
Arasaradnam RP, Brown S, Forbes A, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition[J]. Gut, 2018, 67(8): 1380-1399.
[2]
Wong BS, Camilleri M, Carlson P, et al. Increased bile acid biosynthesis is associated with irritable bowel syndrome with diarrhea[J]. Clin Gastroenterol Hepatol, 2012, 10(9): 1009-1015.e3.
[3]
Valentin N, Camilleri M, Altayar O, et al. Biomarkers for bile acid diarrhoea in functional bowel disorder with diarrhoea: a systematic review and meta-analysis[Z]. Gut, 2016, 65(12): 1951-1959.
[4]
MartÍnez-augustin O, Medina FSD. Intestinal bile acid physiology and pathophysiology[J]. World Journal of Gastroenterology, 2008, 14(37): 5630.
[5]
Ticho AL, Malhotra P, Dudeja PK, et al. Intestinal absorption of bile acids in health and disease[J]. Compr Physiol, 2019, 10(1): 21-56.
[6]
Magnus Y, Bousaba J, Sannaa W, et al. Bile acid diarrhea is associated with increased intestinal permeability compared with irritable bowel syndrome-diarrhea[J]. Gastroenterology, 2022, 162(4): 1343-1345.
[7]
Camilleri M. Bile Acid diarrhea: prevalence, pathogenesis, and therapy[J]. Gut Liver, 2015, 9(3): 332-339.
[8]
Sadowski DC, Camilleri M, Chey WD, et al. Canadian association of gastroenterology clinical practice guideline on the management of bile acid diarrhea[J]. Journal of the Canadian Association of Gastroenterology, 2020, 3(1): e10-e27.
[9]
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]. J Nucl Med, 1982, 23(2): 126-130.
[10]
Black CJ, Ford AC. Biochemical tests for bile acid diarrhea: real-world studies required[J]. Am J Gastroenterol, 2021, 16(4): 833-834.
[11]
Brydon WG, Nyhlin H, Eastwood MA, et al. Serum 7 alpha-hydroxy-4-cholesten-3-one and selenohomocholyltaurine (SeHCAT) whole body retention in the assessment of bile acid induced diarrhoea[J]. Eur J Gastroenterol Hepatol, 1996, 8(2): 117-123.
[12]
Camilleri M, Nadeau A, Tremaine W J, et al. Measurement of serum 7α-hydroxy-4-cholesten-3-one (or 7αC4), a surrogate test for bile acid malabsorption in health, ileal disease and irritable bowel syndrome using liquid chromatography-tandem mass spectrometry[J]. Neurogastroenterology & Motility, 2009, 21(7): 734-743.
[13]
GÄlman C, Angelin B, Rudling M. Bile acid synthesis in humans has a rapid diurnal variation that is asynchronous with cholesterol synthesis[J]. Gastroenterology, 2005, 129(5): 1445-1453.
[14]
Walters J. Making the diagnosis of bile acid diarrhea[J]. Am J Gastroenterol, 2020, 115(12): 1974-1975.
[15]
Mottacki N, SimrÉn M, Bajor A, et al. Review article: bile acid diarrhoea-pathogenesis, diagnosis and management[J]. Alimentary pharmacology & therapeutics, 2016, 43(8): 884-898.
[16]
Vijayvargiya P, Camilleri M, Shin A, et al. Methods for diagnosis of bile acid malabsorption in clinical practice[J]. Clinical Gastroenterology and Hepatology, 2013, 11(10): 1232-1239.
[17]
Walters JR. Bile acid diarrhoea and FGF19: new views on diagnosis, pathogenesis and therapy[J]. Nat Rev Gastroenterol Hepatol, 2014, 11(7): 426-434.
[18]
Chang C, Jiang J, Sun R, et al. Downregulation of serum and distal ileum fibroblast growth factor19 in bile acid diarrhoea patients[J]. Dig Dis Sci, 2022, 67(3): 872-879.
[19]
Pattni SS, Brydon WG, Dew T, et al. Fibroblast growth factor 19 in patients with bile acid diarrhoea: a prospective comparison of FGF19 serum assay and SeHCAT retention[J]. Aliment Pharmacol Ther, 2013, 38(8): 967-976.
[20]
Pattni SS, Brydon GW, 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[J]. Clinical and Translational Gastroenterology, 2012, 3(7): e18.
[21]
Borup C, Syversen C, Bouchelouche P, et al. Diagnosis of bile acid diarrhoea by fasting and postprandial measurements of fibroblast growth factor 19[J]. Eur J Gastroenterol Hepatol, 2015, 27(12): 1399-1402.
[22]
Borup C, Wildt S, Rumessen JJ, et al. Chenodeoxycholic acid stimulated fibroblast growth factor 19 response - a potential biochemical test for bile acid diarrhoea[J]. Aliment Pharmacol Ther, 2017, 45(11): 1433-1442.
[23]
Amplatz B, ZÖhrer E, Haas C, et al. Bile acid preparation and comprehensive analysis by high performance liquid chromatography-high-resolution mass spectrometry[J]. Clin Chim Acta, 2017, 464: 85-92.
[24]
Vijayvargiya P, Camilleri M, Chedid V, et al. Analysis of fecal primary bile acids detects increased stool weight and colonic transit in patients with chronic functional diarrhea[J]. Clinical Gastroenterology and Hepatology, 2019, 17(5): 922-929.
[25]
Vijayvargiya P, Camilleri M, Taylor A, et al. Combined fasting serum c4 and primary bile acids from a single stool sample to diagnose bile acid diarrhea[J]. Gastroenterology, 2020, 159(5): 1952-1954.
[26]
Vijayvargiya P, Gonzalez Izundegui D, Calderon G, et al. Fecal bile acid testing in assessing patients with chronic unexplained diarrhea: implications for healthcare utilization[J]. American Journal of Gastroenterology, 2020, 115(7): 1094-1102.
[27]
Kumar A, Al-hassi HO, Jain M, et al. A single faecal bile acid stool test demonstrates potential efficacy in replacing SeHCAT testing for bile acid diarrhoea in selected patients[J]. Scientific Reports, 2022, 12(1): 8313.
[28]
Vijayvargiya P, Camilleri M. Current practice in the diagnosis of bile acid diarrhea[J]. astroenterology 2019, 156(5): 1233-1238.
[29]
Covington JA, Westenbrink EW, Ouaret N, et al. Application of a novel tool for diagnosing bile acid diarrhoea[J]. Sensors (Basel), 2013, 13(9): 11899-11912.
[30]
Berti G, Rettura F, Lambiase C, et al. Empirical trial or diagnostic tests for bile acid diarrhea? That is the question![J]. Journal of Digestive Diseases, 2021, 22(9): 557-558.
[31]
Ferguson J, Walker K, Thomson AB. Limitations in the use of 14C-glycocholate breath and stool bile acid determinations in patients with chronic diarrhea[J]. 1986, 8(3 Pt 1): 258-262.
[32]
Orekoya O, Mclaughlin J, Leitao E, et al. Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy[J]. Clin Med (Lond), 2015, 15(3): 252-257.
[33]
Watson L, Lalji A, Bodla S, et al. Management of bile acid malabsorption using low-fat dietary interventions: a useful strategy applicable to some patients with diarrhoea-predominant irritable bowel syndrome?[J]. Clinical Medicine (London, England), 2015, 15(6): 536-540.
[34]
Koga T, Nishida T, Miwa H, et al. Effects of dietary butter fat on fecal bile acid excretion in patients with Crohn's disease on elemental diet[J]. Dig Dis Sci, 1984, 29(11): 994-999.
[35]
Walters JRF, Johnston IM, Nolan JD, et al. The response of patients with bile acid diarrhoea to the farnesoid X receptor agonist obeticholic acid[J]. Alimentary Pharmacology & Therapeutics, 2015, 41(1): 54-64.
[36]
Mroz MS, Keating N, Ward JB, et al. Farnesoid X receptor agonists attenuate colonic epithelial secretory function and prevent experimental diarrhoea in vivo[J]. Gut, 2014, 63(5): 808-817.
[37]
Camilleri M, Vijayvargiya P. The role of bile acids in chronic diarrhea[J]. American Journal of Gastroenterology, 2020, 115(10): 1596-1603.
[38]
Lin S, Sanders DS, Gleeson JT, et al. Long-term outcomes in patients diagnosed with bile-acid diarrhoea[J]. Eur J Gastroenterol Hepatol, 2016, 28(2): 240-245.
[39]
Farrugia A, Arasaradnam R. Bile acid diarrhoea: pathophysiology, diagnosis and management[J]. Frontline Gastroenterology, 2021, 12(6): 500-507.
[40]
Wilcox C, Turner J, Green J. Systematic review: the management of chronic diarrhoea due to bile acid malabsorption[J]. Alimentary Pharmacology & Therapeutics, 2014, 39(9): 923-939.
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