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Curr Gastroenterol Rep. 2018 Mar 26;20(3):10. doi: 10.1007/s11894-018-0615-z.

Update on Bile Acid Malabsorption: Finally Ready for Prime Time?

Author information

1
Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Charlton Bldg., Rm. 8-110, 200 First Street S.W, Rochester, MN, 55905, USA.
2
Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Charlton Bldg., Rm. 8-110, 200 First Street S.W, Rochester, MN, 55905, USA. camilleri.michael@mayo.edu.

Abstract

PURPOSE OF REVIEW:

To provide an update on the prevalence, pathophysiology, disease associations, and treatment options for bile acid malabsorption (BAM).

RECENT FINDINGS:

•Molecular mechanisms-BAs prevent water reabsorption and increase water secretion by intracellular mediators, increasing aquaporin channels and intracellular permeability. •Inflammatory bowel disease-new molecular mechanisms of BAM are identified in patients without ileal disease, including changes in expression of ileal BA transporter and nuclear receptors involved in BA homeostasis. •Microscopic colitis-BAM is one of the mechanisms leading to microscopic colitis. •Diagnostic testing-new diagnostic tests have been launched in the USA (serum C4 and fecal 48-h BA excretion); stimulated FGF19 has higher detection of BAM compared to fasting sample alone. •Treatment-investigational FXR agonists may provide a daily, oral option for treatment of BAM instead of BA sequestrants. There is a greater appreciation of the biological role of bile acids across multiple fields of medicine, including gastrointestinal indications.

KEYWORDS:

Bile acid malabsorption; Colonic mechanisms; FXR agonists; Fibroblast growth factor; Inflammatory bowel disease; Microscopic colitis

PMID:
29582208
DOI:
10.1007/s11894-018-0615-z
[Indexed for MEDLINE]

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