Managing bile acid diarrhoea.
Managing bile acid diarrhoea.
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DOI：
10.1177/1756283x10377126
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发表时间：
2010-11-01
影响因子：
4.2
通讯作者：
Pattni, Sanjeev S
中科院分区：
文献类型：
--
作者：
Walters, Julian R F;Pattni, Sanjeev S
当结肠中存在过量胆汁酸（BA）时，可产生包括腹泻在内的肠道症状。这种情况，称为胆汁酸或胆汁盐吸收不良，一直被认为是最好的诊断方法，（75）硒-高胆酸牛磺酸（SeHCAT）测试，在许多国家不可用，在其他国家也没有得到充分利用。SeHCAT滞留减少表明这是许多其他胃肠道疾病的并发症。反复的研究表明，SeHCAT测试在约30%的患者中异常，否则诊断为肠易激综合征或功能性腹泻，估计人群患病率约为1%。最近的工作表明，以前称为特发性胆汁酸吸收不良（BAM）的条件实际上不是由于吸收缺陷，而是由于BA的过度产生，因为肝胆汁酸合成的反馈抑制缺陷，回肠激素成纤维细胞生长因子19（FGF 19）的功能。目前的治疗方法依赖于结合过量的BA，以减少其分泌作用，使用考来烯胺，考来替泊和最近的考来维仑。Colesevelam具有许多潜在优势，值得在针对胆汁酸腹泻患者的试验中进一步研究。
Bowel symptoms including diarrhoea can be produced when excess bile acids (BA) are present in the colon. This condition, known as bile acid or bile salt malabsorption, has been under recognized, as the best diagnostic method, the (75)Se-homocholic acid taurine (SeHCAT) test, is not available in many countries and is not fully utilized in others. Reduced SeHCAT retention establishes that this is a complication of many other gastrointestinal diseases. Repeated studies show SeHCAT tests are abnormal in about 30% of patients otherwise diagnosed as diarrhoea-predominant irritable bowel syndrome or functional diarrhoea, with an estimated population prevalence of around 1%. Recent work suggests that the condition previously called idiopathic bile acid malabsorption (BAM) is not in fact due to a defect in absorption, but results from an overproduction of BA because of defective feedback inhibition of hepatic bile acid synthesis, a function of the ileal hormone fibroblast growth factor 19 (FGF19). The approach to treatment currently depends on binding excess BA, to reduce their secretory actions, using colestyramine, colestipol and, most recently, colesevelam. Colesevelam has a number of potential advantages that merit further investigation in trials directed at patients with bile acid diarrhoea.