Related Experiment Video
Updated: Nov 6, 2025
Using Multi-fluorinated Bile Acids and In Vivo Magnetic Resonance Imaging to Measure Bile Acid Transport
Published on: November 27, 2016
Markers of Bile Acid Metabolism in Pediatric Diarrhea Predominant Irritable Bowel Syndrome and Healthy Controls
Beate C Beinvogl1, Mhd Louai Manini2, Michael Camilleri3
1Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA.
Insights
This study investigated bile acid diarrhea (BAD) in children with irritable bowel syndrome with diarrhea (IBS-D). Abnormal serum markers were found in 20% of pediatric IBS-D patients, suggesting a potential diagnostic role for C4 testing.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Digestive Diseases
Background:
- Excessive fecal bile acids are linked to diarrhea-predominant irritable bowel syndrome (IBS-D) in adults.
- The role of bile acid diarrhea (BAD) in pediatric IBS-D remains unclear.
- Serum markers 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor-19 (FGF-19) can detect BAD in adults.
Purpose of the Study:
- To assess serum C4, FGF-19, and 48-hour fecal bile acid (48FBA) in pediatric IBS-D patients and healthy controls (HC).
- To compare these markers between pediatric IBS-D patients and HC.
- To determine the prevalence of BAD in children with IBS-D.
Main Methods:
- Cross-sectional study involving 26 pediatric IBS-D patients and 56 HC.
- Collected fasting serum C4 and FGF-19, and 48FBA.
- Analyzed correlations between markers and stool frequency using Spearman correlations.
Main Results:
- Serum C4 correlated significantly with 48FBA (r=0.48) and inversely with FGF-19 (r=-0.43).
- No significant differences in C4, FGF-19, or 48FBA were found between IBS-D and HC groups.
- Twenty percent of pediatric IBS-D patients exhibited elevated serum C4, and 28% had low FGF-19.
Conclusions:
- The correlations between C4, 48FBA, and FGF-19 are confirmed in a pediatric cohort.
- Abnormal fasting serum C4 was observed in 20% of pediatric IBS-D patients.
- Serum C4 testing shows potential for identifying BAD in pediatric IBS-D.
Objectives:
Excessive fecal bile acids in adults have been associated with diarrhea-predominant irritable bowel syndrome (IBS-D), but their role in pediatric IBS-D is unknown. Serum markers including 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor-19 (FGF-19) were validated in adults to detect bile acid diarrhea (BAD) compared to 48-hour fecal bile acid collection (48FBA). Our aims were to assess fasting serum C4 and FGF-19 and 48FBA in a pediatric population, to compare measurements in IBS-D patients and healthy controls (HC), and to determine the prevalence of BAD among children with IBS-D.
Methods:
Using a cross-sectional design, 26 patients with IBS-D and 56 HC were recruited in two pediatric tertiary care centers. Fasting serum C4 and FGF-19 and 48FBA were obtained. Participants completed a 7-day bowel diary coinciding with stool collection. Associations were analyzed using Spearman correlations.
Results:
Mean age was 14.7 ± 2.5 years (42.3% female) in IBS-D and 12.6 ± 2.4 years (39.3% female) in HC. There was a significant correlation of C4 with 48FBA (r = 0.48, P < 0.05) and an inverse association with FGF-19 (r = -0.43, P < 0.05). No significant differences were noted in C4 (P = 0.32), FGF-19 (P = 0.1), or 48FBA (P = 0.5) between IBS-D and HC groups; however, 20% of IBS-D patients had elevated C4 and 28% had low FGF-19 values.Fecal primary BA was significantly correlated with stool frequency (r = 0.45, P < 0.002).
Conclusions:
Correlations of C4 with 48FBA and FGF-19 are confirmed in a pediatric population. Twenty percent of pediatric patients with IBS-D had abnormal fasting serum C4. This serum test could be applied to identify BAD in pediatric IBS-D.
Related Concept Videos
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are:
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:17Irritable Bowel Syndrome I: Introduction
IBS is a chronic condition that can persist over a long period or recur frequently.
The pathogenesis of IBS involves a complex interplay of the following factors:
Altered...
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption