Serum unconjugated bile acids in patients with small bowel bacterial overgrowth (original) (raw)
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Journal of Parenteral and Enteral Nutrition, 2018
OBJECTIVE-We determined qualitative and quantitative serum unconjugated bile acid (SUBA) levels among children with history of intestinal failure (IF) and suspected small bowel bacterial overgrowth (SBBO). METHODS-This was a single center case-control pilot study conducted at Cincinnati Children's Hospital Medical Center. Children with history of IF and suspected SBBO were enrolled as subjects. Age matched children without IF or suspected SBBO served as controls. All participants underwent small bowel fluid sampling for microbial culture analysis. Additionally, serum fractionated and total bile acids were measured by liquid chromatography-mass spectrometry (LC-MS) at enrollment and following treatment for SBBO. RESULTS-SUBA concentrations were elevated in IF subjects (1.16 μM, range 0.43-10.65) compared to controls (0.10 μM, range 0.05-0.18), p=0.001. Among SUBA, chenodeoxycholic acid (CDCA) was significantly elevated in subjects (0.8 μM, range 0-7.08) compared to controls (0 μM, range 0-0.03), p=0.012. When controls were excluded from analysis, IF subjects with positive aspirates for SBBO demonstrated higher concentration of CDCA (median 7.36 μM, range 1.1-8.28) compared to IF subjects with negative aspirates (median 0.18 μM, range 0-1.06), p=0.017. Treatment for SBBO did not alter SUBA concentration.
Serum unconjugated bile acids as a test for intestinal bacterial overgrowth in dogs
Digestive diseases and sciences, 2000
Small intestinal bacterial overgrowth (SIBO) has a high incidence in dogs and, as in humans, is difficult to diagnose. The aim of this study was to determine the diagnostic significance of serum unconjugated bile acid concentrations in dogs with bacterial overgrowth. Fasting sera were obtained from 23 dogs: 10 with culture-proven SIBO, 8 with indirectly diagnosed SIBO (normal pancreatic function but small intestinal disease associated with subnormal serum cobalamin and supranormal folate concentrations), and 5 healthy controls. Unconjugated bile acids were determined using gas chromatography-mass spectrometry after isolation by liquid-solid extraction and anion-exchange chromatography. Mean serum unconjugated bile acid concentrations were significantly elevated in dogs with SIBO (mean +/- SD: 0.91 +/- 1.03 micromol/liter), and in dogs with indirectly diagnosed SIBO (2.11 +/- 2.20 micromol/liter) compared to clinically healthy dogs (0.015 +/- 0.015 micromol/liter, P < 0.005). Chol...
Application of a Novel Tool for Diagnosing Bile Acid Diarrhoea
Sensors, 2013
Bile acid diarrhoea (BAD) is a common disease that requires expensive imaging to diagnose. We have tested the efficacy of a new method to identify BAD, based on the detection of differences in volatile organic compounds (VOC) in urine headspace of BAD vs. ulcerative colitis and healthy controls. A total of 110 patients were recruited; 23 with BAD, 42 with ulcerative colitis (UC) and 45 controls. Patients with BAD also received standard imaging (Se75HCAT) for confirmation. Urine samples were collected and the headspace analysed using an AlphaMOS Fox 4000 electronic nose in combination with an Owlstone Lonestar Field Asymmetric Ion Mobility Spectrometer (FAIMS). A subset was also tested by gas chromatography, mass spectrometry (GCMS). Linear Discriminant
Gastroenterology, 1987
We studied radiolabeled fecal bile acid excretion in 11 normal subjects and 17 patients with idiopathic chronic diarrhea for three major purposes: (a) to establish normal values for this test in the presence of increased stool volumes (induced in normal subjects by ingestion of poorly absorbable solutions); [b) to test for bile acid malabsorption in the patients and to correlate this with an independent test of ilea function, the SchiIIing test; and [c) to compare the results of the bile acid excretion test with the subsequent effect of a bile acid binding agent (cho-Iestyramine) on stool weight. In normal subjects fecal excretion of the radiolabel was increased with increasing stool volumes. As a group, patients with idiopathic chronic diarrhea excreted radiolabeled bile acid more rapidly than normal subjects with induced diarrhea (t 1,2 56 + 8 vs. 236 k 60 h, respectively, p < 0.005). There was a statistically significant positive correlation between t1/2 of radiolabeled bile acid and SchiIIing test results in these patients. Although 14 of 17 patients absorbed Iabeled taurocholic acid less we11 than any of the normal subjects with comparable volumes of induced diarrhea, cholestyramine had no statistically significant effect on stool weight in the patient
Gastroenterology, 2018
Table 1: Menopausal Factors, Menopausal Hormone Therapy (MHT) Use, and Risk of Microscopic Colitis amongst post-menopausal women in the Nurses' Health Study (NHS) and NHSII [1] Adjusted for age (months), cohort (NHS, NHS2), body mass index (<20, 20-24.9, 25-29.9, $30), smoking (never, past, current), age of menarche (years), oral contraceptive use (never, ever), age of menopause (years), and menopause type (natural, surgical/radiation). [2] P-trend was estimated by entering Years since MHT discontinuation in the model as a continuous variable excluding the "Never Use" category 195
Diagnostic value of serum primary bile acids in detecting bile acid malabsorption
Gut, 1982
Serum cholic and chenodeoxycholic acid conjugates were measured in fasting conditions and after meals in 14 patients with bile acid malabsorption due to ileal resection. Mean serum fasting levels of both primary bile acids did not differ from the controls. After meals, serum cholic acid peaks were lower in patients with ileal resection than in control subjects (p<O.OO1), while chenodeoxycholic acid peaks were reduced in colectomised patients (p<OO1). In the sera from patients with ileal resection, the glycine/glycine + taurine ratio for cholic and chenodeoxycholic acid increased (p<O.OO1) from morning to evening, and glycine/glycine + taurine ratio for chenodeoxycholic acid was significantly (p<OO1) different from the controls in the sera collected in the evening. The results are consistent with the concept of a better intestinal conservation of chenyl, mainly of the glycine conjugated form, than of cholylconjugates, in patients with ileal resection; this is probably because of passive absorption in the intestine. The postprandial peaks of serum cholic acid conjugates may therefore be regarded as a test of ileal dysfunction, while peaks of chenodeoxycholic acid conjugates suggest colonic impairment.
Prevalence of, and predictors of, bile acid malabsorption in outpatients with chronic diarrhea
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2012
Background Many physicians do not consider the diagnosis of bile acid malabsorption in patients with chronic diarrhea, or do not have access to testing. We examined yield of 23-seleno-25-homo-tauro-cholic acid (SeHCAT) scanning in chronic diarrhea patients, and attempted to identify predictors of a positive test.Methods Consecutive patients with chronic diarrhea undergoing SeHCAT scan over a 7-year period were identified retrospectively. Bile acid malabsorption was defined as present at a retention of <15%. Medical records were reviewed to obtain information regarding proposed risk factors. Gastrointestinal symptoms were recorded, and patients were classified as having diarrhea-predominant irritable bowel syndrome (IBS-D) if they reported abdominal pain or discomfort. Independent risk factors were assessed using multivariate logistic regression, and odds ratios (ORs) with 99% confidence intervals (CIs) were calculated.Key Results Of 373 patients, 190 (50.9%) had bile acid malabsorption. Previous cholecystectomy (OR 2.51; 99% CI 1.10–5.77), terminal ileal resection or right hemicolectomy for Crohn’s disease (OR 12.4; 99% CI 2.42–63.8), and terminal ileal resection or right hemicolectomy for other reasons (OR 7.94; 99% CI 1.02–61.6) were associated with its presence. Seventy-seven patients had IBS-D, and 21 (27.3%) tested positive. There were 168 patients with no risk factors for a positive SeHCAT scan, other than chronic diarrhea, and 63 (37.5%) had bile acid malabsorption.Conclusions & Inferences Bile acid malabsorption was present in 50% of patients undergoing SeHCAT scanning. Almost 40% of those without risk factors had evidence of bile acid malabsorption, and in those meeting criteria for IBS-D prevalence was almost 30%.
Methods for Diagnosing Bile Acid Malabsorption: A Systematic Review
BackgroundBile acid malabsorption (BAM) and bile acid-related diarrhea represent an under-recognized cause of chronic diarrhea mainly because of limited guidance on appropriate diagnostic and laboratory tests.ObjectiveTo perform a systematic review of the literature in order to identify and compare the diagnostic accuracy of different diagnostic methods for patients with bile acid malabsorption.DesignA PubMed literature review and a manual search were carried out. Relevant full papers, evaluating the diagnostic accuracy of different methods for BAM, were assessed. Available data were analyzed to estimate the sensitivity and specificity of each published test.ResultsOverall, more than one tests was considered in published papers on BAM. The search strategy retrieved 574 articles; of these, only 16 were full papers (with a total of 2.332 patients) included in the final review. Specifically, n=8 studies used 75 Selenium-homotaurocholic-acid-test ( 75 SeHCAT) with a <10% retention th...
Digestive Diseases and Sciences, 2001
Bile acid malabsorption (BAM) has been described in patients with collagenous colitis. There are no similar studies in lymphocytic colitis. The possibility that BAM might not necessarily be part of the microscopic colitis process and that both entities could simply be concomitant has not been evaluated. Our aim was to assess the frequency and severity of BAM in patients with microscopic colitis as well as in patients with previously unexplained functional chronic diarrhea. Likewise, we wanted to investigate the effect of cholestyramine on the induction and maintenance of remission of these conditions. A [75Se]HCAT abdominal retention test was performed in 26 patients with collagenous colitis, 25 with lymphocytic colitis, and 32 with previously unexplained functional chronic diarrhea. Patients with microscopic colitis who had BAM as well as a subgroup of eight collagenous colitis patients without BAM received treatment with cholestyramine. All patients with previously unexplained chronic diarrhea who had BAM were treated with cholestyramine. Twenty-two (43.1%) patients with microscopic colitis and 24 (75%) patients with previously unexplained functional chronic diarrhea presented with BAM. The frequency of BAM was higher in lymphocytic colitis than in collagenous colitis (60% vs 27%; P = 0.025). Cholestyramine induced clinical remission in 19 of 22 patients with microscopic colitis and BAM, none of eight patients with collagenous colitis without BAM, and all patients with previously unexplained chronic diarrhea and BAM. In conclusion, BAM seems to be common in patients with microscopic colitis—mainly in lymphocytic colitis—and in those with previously unexplained functional chronic diarrhea, suggesting that idiopathic BAM and microscopic colitis are often concomitant conditions. In this setting, cholestyramine seems to be highly effective in stopping diarrhea.