Bile acid malabsorption (BAM) represents a common cause of chronic diarrhea whose prevalence is under-investigated. We reviewed the evidence available regarding the pathophysiology and clinical management of bile acid diarrhea (BAD). BAD results from dysregulation of the enterohepatic recirculation of bile acids. It has been estimated that 25-33% of patients with functional diarrhea and irritable bowel syndrome with diarrhea have BAM. Currently, the selenium homotaurocholic acid test is the gold standard for BAD diagnosis and severity assessment. However, it is an expensive method and not widely available. The validation of the utility in the clinical practice of several other serum markers, such as 7 alpha-hydroxy-4-cholesten-3-one (C4) and the fibroblast growth factor 19 (FGF19) is ongoing. The first-line treatment of patients with BAD is bile acid sequestrants. Patients that are refractory to first-line therapy should undergo further diagnostics to confirm the diagnosis and to treat the underlying cause of BAD. An early and correct diagnosis of BAD would improve patient's quality of life, avoiding additional diagnostic tests that burden health care systems. Considering the limited availability and tolerability of specific medications for BAD treatment, future research is awaited to identify other therapeutic approaches, such as gut microbiota modulating therapies.

Pathophysiology and Clinical Management of Bile Acid Diarrhea / Marasco, Giovanni; Cremon, Cesare; Barbaro, Maria Raffaella; Falangone, Francesca; Montanari, Davide; Capuani, Federica; Mastel, Giada; Stanghellini, Vincenzo; Barbara, Giovanni. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - ELETTRONICO. - 11:11(2022), pp. 3102.1-3102.21. [10.3390/jcm11113102]

Pathophysiology and Clinical Management of Bile Acid Diarrhea

Marasco, Giovanni;Barbaro, Maria Raffaella;Montanari, Davide;Capuani, Federica;Mastel, Giada;Stanghellini, Vincenzo;Barbara, Giovanni
2022

Abstract

Bile acid malabsorption (BAM) represents a common cause of chronic diarrhea whose prevalence is under-investigated. We reviewed the evidence available regarding the pathophysiology and clinical management of bile acid diarrhea (BAD). BAD results from dysregulation of the enterohepatic recirculation of bile acids. It has been estimated that 25-33% of patients with functional diarrhea and irritable bowel syndrome with diarrhea have BAM. Currently, the selenium homotaurocholic acid test is the gold standard for BAD diagnosis and severity assessment. However, it is an expensive method and not widely available. The validation of the utility in the clinical practice of several other serum markers, such as 7 alpha-hydroxy-4-cholesten-3-one (C4) and the fibroblast growth factor 19 (FGF19) is ongoing. The first-line treatment of patients with BAD is bile acid sequestrants. Patients that are refractory to first-line therapy should undergo further diagnostics to confirm the diagnosis and to treat the underlying cause of BAD. An early and correct diagnosis of BAD would improve patient's quality of life, avoiding additional diagnostic tests that burden health care systems. Considering the limited availability and tolerability of specific medications for BAD treatment, future research is awaited to identify other therapeutic approaches, such as gut microbiota modulating therapies.
2022
Pathophysiology and Clinical Management of Bile Acid Diarrhea / Marasco, Giovanni; Cremon, Cesare; Barbaro, Maria Raffaella; Falangone, Francesca; Montanari, Davide; Capuani, Federica; Mastel, Giada; Stanghellini, Vincenzo; Barbara, Giovanni. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - ELETTRONICO. - 11:11(2022), pp. 3102.1-3102.21. [10.3390/jcm11113102]
Marasco, Giovanni; Cremon, Cesare; Barbaro, Maria Raffaella; Falangone, Francesca; Montanari, Davide; Capuani, Federica; Mastel, Giada; Stanghellini, Vincenzo; Barbara, Giovanni
File in questo prodotto:
File Dimensione Formato  
Marasco 2022-JCM.pdf

accesso aperto

Tipo: Versione (PDF) editoriale
Licenza: Licenza per Accesso Aperto. Creative Commons Attribuzione (CCBY)
Dimensione 985.76 kB
Formato Adobe PDF
985.76 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/894902
Citazioni
  • ???jsp.display-item.citation.pmc??? 2
  • Scopus 11
  • ???jsp.display-item.citation.isi??? 7
social impact