Bile Acid Malabsorption in Inflammatory Bowel Disease: Assessment by Serum Markers
Bile Acid Malabsorption in Inflammatory Bowel Disease: Assessment by Serum Markers
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DOI：
10.1002/ibd.21502
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发表时间：
2011-06-01
影响因子：
4.9
通讯作者：
Vitek, Libor
中科院分区：
文献类型：
--
作者：
Lenicek, Martin;Duricova, Dana;Vitek, Libor
背景：胆汁酸吸收不良（BAM）是克罗恩病（CD）的常见特征。我们的目的是确定BAM是否只发生在回肠远端切除的患者中，或者是否也发生在未接受CD手术的患者中。方法：本研究包括347例CD或溃疡性结肠炎（UC）患者和119例健康受试者（对照组）。通过测量7 α-羟基胆甾-4-烯-3-酮（C4）和成纤维细胞生长因子19（FGF 19）的血清水平评估BAM。我们调查了欧洲克罗恩病和结肠炎组织和炎症性肠病研究国际组织的成员，以收集目前的信息BAM diagnosis.Results：BAM的严重程度与切除远端回肠。与对照组相比，接受中度或广泛回肠切除术的患者血清C4水平显著升高（分别为12、62和243 μ g/L; P < 0.001）。然而，BAM也存在于大量未接受手术治疗的CD患者中，这些患者患有回肠炎或结肠炎（分别为14%和11%）。C4和FGF 19水平之间存在间接的比例关系（P < 0.001）。结论：回肠末端切除后的CD患者发生最严重的BAM，但BAM可发生在未经手术治疗的CD患者，无论疾病部位如何。BAM的实验室检查应成为CD诊断算法的一部分，以识别可能对胆汁酸螯合剂等治疗有反应的患者。FGF 19似乎是BAM的可靠标志物。
Background: Bile acid malabsorption (BAM) is a common feature of Crohn's disease (CD). We aimed to determine whether BAM develops only in patients with a resected distal ileum or if it also occurs in patients who have not undergone surgery for CD.Methods: The study included 347 patients with CD or ulcerative colitis (UC) and 119 healthy subjects (controls). BAM was assessed by measurement of serum levels of 7 alpha-hydroxycholest-4-en-3-one (C4) and fibroblast growth factor 19 (FGF19). We surveyed members of the European Crohn's and Colitis Organization and International Organization for the Study of Inflammatory Bowel Disease to collect current information about BAM diagnosis.Results: The severity of BAM was associated with resection of the distal ileum. Compared with controls, patients who received moderate or extensive ileal resection had significantly increased levels of serum C4 (12 versus 62 versus 243 mu g/L, respectively; P < 0.001). However, BAM was also present in a substantial number of the patients with CD who were not treated by surgery who had ileitis or colitis (14% and 11%, respectively). There was an indirect, proportional relationship between levels of C4 and FGF19 (P < 0.001).Conclusions: The most severe BAM occurs in CD patients after resection of the distal ileum, but BAM can occur in surgically untreated CD patients, regardless of disease localization. Laboratory tests for BAM should become a part of the algorithm for diagnosis of CD to identify patients who might respond to therapies such as bile acid sequestrants. FGF19 appears to be a reliable marker of BAM.