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Response to KÃ¥rhus et al. Regarding "<i>Ruminococcus gnavus</i> and Biofilm Markers in Feces From Primary Bile Acid Diarrhea Patients Indicate New Disease Mechanisms and Potential for Diagnostic Testing".

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Updated: Jun 5, 2026

Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport
08:42

Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport

Published on: November 27, 2016

Managing bile acid diarrhoea.

Julian R F Walters1, Sanjeev S Pattni

  • 1Section of Hepatology and Gastroenterology, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.

Therapeutic Advances in Gastroenterology
|December 25, 2010
PubMed
Summary
This summary is machine-generated.

Bile acid diarrhoea, often underdiagnosed, occurs when excess bile acids reach the colon. New research suggests it stems from overproduction, not malabsorption, and may benefit from treatments like colesevelam.

Keywords:
Crohn's diseaseSeHCATbile acidscolesevelamcolestipolcolestyraminefibroblast growth factor 19functional diarrhoeairritable bowel syndromemalabsorption

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Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport
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Ileectomy-induced Bile Overaccumulation in Mouse Intestine

Published on: August 21, 2017

Area of Science:

  • Gastroenterology
  • Hepatology
  • Endocrinology

Background:

  • Bowel symptoms like diarrhea can result from excess bile acids (BA) in the colon, a condition termed bile acid malabsorption (BAM).
  • BAM is frequently underdiagnosed due to limited availability and utilization of the SeHCAT test.
  • Abnormal SeHCAT retention is found in approximately 30% of patients with diarrhea-predominant irritable bowel syndrome or functional diarrhea, suggesting a 1% population prevalence.

Purpose of the Study:

  • To investigate the underlying mechanisms of bile acid diarrhoea.
  • To explore the role of fibroblast growth factor 19 (FGF19) in regulating bile acid synthesis.
  • To evaluate the potential of novel treatments for bile acid diarrhoea.

Main Methods:

  • Utilized the (75)Se-homocholic acid taurine (SeHCAT) test to assess bile acid retention.
  • Investigated the feedback inhibition of hepatic bile acid synthesis.
  • Reviewed current treatment strategies involving bile acid sequestrants.

Main Results:

  • Reduced SeHCAT retention indicates BAM as a complication of various gastrointestinal diseases.
  • Recent findings suggest idiopathic BAM is due to excessive BA production from defective FGF19 feedback inhibition.
  • Current treatments focus on binding excess BA using agents like colestyramine, colestipol, and colesevelam.

Conclusions:

  • Bile acid diarrhoea is an under-recognized condition with significant prevalence.
  • Defective feedback inhibition of bile acid synthesis by FGF19 may be the primary cause of "idiopathic" BAM.
  • Colesevelam shows promise as a treatment option for bile acid diarrhoea, warranting further clinical investigation.