Methods for Diagnosis of Bile Acid Malabsorption in Clinical Practice

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Presentation transcript:

Methods for Diagnosis of Bile Acid Malabsorption in Clinical Practice Priya Vijayvargiya, Michael Camilleri, Andrea Shin, Amy Saenger Clinical Gastroenterology and Hepatology Volume 11, Issue 10, Pages 1232-1239 (October 2013) DOI: 10.1016/j.cgh.2013.04.029 Copyright © 2013 AGA Institute Terms and Conditions

Figure 1 BA chemistry: CDCA, CA, DCA, LCA, and ursodeoxycholic acid (UDCA). Clinical Gastroenterology and Hepatology 2013 11, 1232-1239DOI: (10.1016/j.cgh.2013.04.029) Copyright © 2013 AGA Institute Terms and Conditions

Figure 2 Hepatic synthesis of BA from cholesterol involves entry into hepatocytes of low-density lipoprotein (LDL) cholesterol by binding to LDL receptors on the hepatocyte cell surface. Up-regulation of hepatic BA synthesis promotes maintenance of BA pool size and leads to an increase in serum C4, a surrogate for the activity of cholesterol 7 α-hydroxylase, the rate-limiting enzyme in hepatic BA synthesis. LBAT, liver bile acid transporter. Adapted with permission from Wong BS, et al. Am J Gastroenterol 2011;106:2154-2164. Clinical Gastroenterology and Hepatology 2013 11, 1232-1239DOI: (10.1016/j.cgh.2013.04.029) Copyright © 2013 AGA Institute Terms and Conditions

Figure 3 Variation in BA excretion per gram fecal weight in each bowel movement in a single patient. Data show median, interquartile range, 5th and 95th percentiles, and each individual value. Data from Mitchell WD, et al. Gut 1973;14:348-353. Clinical Gastroenterology and Hepatology 2013 11, 1232-1239DOI: (10.1016/j.cgh.2013.04.029) Copyright © 2013 AGA Institute Terms and Conditions

Figure 4 (A) 75SeHCAT values and total fecal BAs of 9 patients. Vertical dotted line marks the lower normal limit for total fecal BAs (250 mg/day). Reproduced from Sciaretta G, et al. Gut 1987;28:970-975. (B) Relationship between half-life of 75SeHCAT and HCO (7 α-hydroxy-4-cholesten-3-one) serum concentrations in patients with diarrhea of unknown origin. The response to treatment is indicated by different symbols (○ = response to treatment, ▪= no response to treatment, ●= response not evaluated). The dark gray shaded area denotes pathologic values for both tests; the light gray shaded area denotes normal values for both tests. Modified with permission from Sauter GH, et al. Dig Dis Sci 1999;44:14-19. Clinical Gastroenterology and Hepatology 2013 11, 1232-1239DOI: (10.1016/j.cgh.2013.04.029) Copyright © 2013 AGA Institute Terms and Conditions

Figure 5 (A and B) Quantification of serum C4 and total stool BAs in IBS-constipation, IBS-diarrhea, and healthy controls. Data show median and interquartile ranges, 5th and 95th percentiles. Note the higher serum C4 and fecal total BAs excreted during 48 hours in patients with IBS-diarrhea. (C) Relationship between fasting serum C4 and total 48-hour stool BA excretion. Adapted from Wong BS, et al. Clin Gastroenterol Hepatol 2012;10:1009-1015. Clinical Gastroenterology and Hepatology 2013 11, 1232-1239DOI: (10.1016/j.cgh.2013.04.029) Copyright © 2013 AGA Institute Terms and Conditions