#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Bile acid malabsorption in oncology patients


Authors: D. Kohoutová 1,2 ;  D. Zogala 3 ;  J. Doležal 4 ;  O. Lang 5,6 ;  J. Bureš 1,7,8
Authors place of work: Centrum biomedicínského výzkumu, FN Hradec Králové 1;  The Royal Marsden NHS Foundation Trust, London 2;  Ústav nukleární medicíny 1. LF UK a VFN v Praze 3;  Oddělení nukleární medicíny, FN Hradec Králové 4;  Klinika nukleární medicíny 3. LF UK a FN Královské Vinohrady, Praha 5;  Oddělení nukleární medicíny, Prague Medical Care Department, Praha 6;  Ústav gastrointestinální onkologie ÚVN – Vojenská fakultní nemocnice Praha 7;  Interní klinika 1. LF UK a ÚVN – Vojenská fakultní nemocnice Praha 8
Published in the journal: Gastroent Hepatol 2022; 76(5): 399-408
Category: Gastrointestinal Oncology: Review Article
doi: https://doi.org/10.48095/ccgh2022399

Summary

Bile acid malabsorption (BAM) is caused by dysregulation of enterohepatic circulation of bile acids and their synthesis in the liver. Estimated prevalence is about 1% of adult population. BAM has been substantially underdiagnosed. This condition can be present in one third of patients with diarrhoea-predominant irritable bowel syndrome and in 50–100% of Crohn‘s disease with ileitis or previously resected terminal ileum. Up to one half of oncology patients with pelvic radiotherapy suffer from BAM. SeHCAT test (75Selenium HomoCholic Acid Taurine test) is the gold diagnostic standard and the test has just become available in the Czech Republic. Low-fat diet is the most important dietary modification. Bile acids sequestrants (cholestyramine in the Czech Republic) are the crucial part of pharmacotherapy.

Keywords:

bile acid malabsorption – SeHCAT test – cholestyramine


Zdroje

1. Hofmann AF. The syndrome of ileal disease and the broken enterohepatic circulation: cholerheic enteropathy. Gastroenterology 1967; 52 (4): 752–757.

2. Camilleri M, Vijayvargiya P. The Role of Bile Acids in Chronic Diarrhea. Am J Gastroenterol 2020; 115 (10): 1596–1603. doi: 10.14309/ajg.0000000000000696.

3. Marasco G, Cremon C, Barbaro MR et al. Pathophysiology and Clinical Management of Bile Acid Diarrhea. J Clin Med 2022; 11 (11): 3102. doi: 10.3390/jcm11113102.

4. Kohoutová D. Malabsorpce žlučových kyselin. In: Zavoral M, Bureš J, Ryska M et al. Mařatkova gastroenterologie. Praha: Karolinum 2021; 1485–1489.

5. Bunnett NW. Neuro-humoral signalling by bile acids and the TGR5 receptor in the gastrointestinal tract. J Physiol 2014; 592 (14): 2943–2950. doi: 10.1113/jphysiol.2014.271155.

6. Vítek L. Bile acid malabsorption in inflammatory bowel disease. Inflamm Bowel Dis 2015; 21 (2): 476–483. doi: 10.1097/MIB.0000000000000193.

7. Barkun AN, Love J, Gould M et al. Bile acid malabsorption in chronic diarrhea: pathophysiology and treatment. Can J Gastroenterol 2013; 27 (11): 653–659. doi: 10.1155/2013/485631.

8. Vanuytsel T, Tack J, Farre R. The Role of Intestinal Permeability in Gastrointestinal Disorders and Current Methods of Evaluation. Front Nutr 2021; 8: 717925. doi: 10.3389/fnut.2021.717 925.

9. Jeffery IB, Das A, O‘Herlihy E et al. Differences in Fecal Microbiomes and Metabolomes of People With vs Without Irritable Bowel Syndrome and Bile Acid Malabsorption. Gastroenterology 2020; 158 (4): 1016–1028.e8. doi: 10.1053/ j.gastro.2019.11.301.

10. Sagar NM, Duboc H, Kay GL et al. The pathophysiology of bile acid diarrhoea: differences in the colonic microbiome, metabolome and bile acids. Sci Rep 2020; 10 (1): 20436. doi: 10.1038/s41598-020-77374-7.

11. Joyce SA, Gahan CGM. Bile Acid Modifications at the Microbe-Host Interface: Potential for Nutraceutical and Pharmaceutical Interventions in Host Health. Annu Rev Food Sci Technol 2016; 7: 313–333. doi: 10.1146/annu rev-food-041715-033159.

12. Singh J, Metrani R, Shivanagoudra SR et al. Review on Bile Acids: Effects of the Gut Microbiome, Interactions with Dietary Fiber, and Alterations in the Bioaccessibility of Bioactive Compounds. J Agric Food Chem 2019; 67 (33): 9124–9138. doi: 10.1021/acs.jafc.8b07306.

13. Pawlyn C, Khan MS, Muls A et al. Lenalidomide-induced diarrhea in patients with myeloma is caused by bile acid malabsorption that responds to treatment. Blood 2014; 124 (15): 2467–2468. doi: 10.1182/blood-2014-06-583302.

14. Walters JRF, Arasaradnam R, Andreyev HJN; UK Bile Acid Related Diarrhoea Network. Diagnosis and management of bile acid diarrhoea: a survey of UK expert opinion and practice. Frontline Gastroenterol 2019; 11 (5): 358–363. doi: 10.1136/flgastro-2019-101301.

15. Fernandes DCR, Poon D, White LL et al. What is the cost of delayed diagnosis of bile acid malabsorption and bile acid diarrhoea? Frontline Gastroenterol 2019; 10 (1): 72–76. doi: 10.1136/flgastro-2018-101011.

16. Farrugia A, Arasaradnam R. Bile acid diarrhoea: pathophysiology, diagnosis and management. Frontline Gastroenterol 2020; 12 (6): 500–507. doi: 10.1136/flgastro-2020-101436.

17. Habba SF. Chronic diarrhea: identifying a new syndrome. Am J Gastroenterol 2000; 95 (8): 2140–2141. doi: 10.1111/j.1572-0241.2000.02 219.x.

18. Appleby RN, Moghul I, Khan S et al. Non-alcoholic fatty liver disease is associated with dysregulated bile acid synthesis and diarrhea: A prospective observational study. PLoS One 2019; 14 (1): e0211348. doi: 10.1371/journal.pone.0211348.

19. Camilleri M. Bile Acid diarrhea: prevalence, pathogenesis, and therapy. Gut Liver 2015; 9 (3): 332–339. doi: 10.5009/gnl14397.

20. Kurien M, Thurgar E, Davies A et al. Challenging current views on bile acid diarrhoea and malabsorption. Frontline Gastroenterol 2018; 9 (2): 92–97. doi: 10.1136/flgastro-2017-100808.

21. Wedlake L, A‘Hern R, Russell D et al. Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2009; 30 (7): 707–717. doi: 10.1111/j.1365-2036.2009.04081.x.

22. Slattery SA, Niaz O, Aziz Q et al. Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea. Aliment Pharmacol Ther 2015; 42 (1): 3–11. doi: 10.1111/apt.13227.

23. Flores V, Martínez-Lozano H, Bighelli F et al. Prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics: a prospective study. BMC Gastroenterol 2021; 21 (1): 56. doi: 10.1186/s12 876-021-01637-4.

24. Smith MJ, Cherian P, Raju GS et al. Bile acid malabsorption in persistent diarrhoea. J R Coll Physicians Lond 2000; 34 (5): 448–451.

25. Lenicek M, Duricova D, Komarek V et al. Bile acid malabsorption in inflammatory bowel disease: assessment by serum markers. Inflamm Bowel Dis 2011; 17 (6): 1322–1327. doi: 10.1002/ibd.21502.

26. Gracie DJ, Kane JS, Mumtaz S et al. Prevalence of, and predictors of, bile acid malabsorption in outpatients with chronic diarrhea. Neurogastroenterol Motil 2012; 24 (11): 983–e538. doi: 10.1111/j.1365-2982.2012.01953.x.

27. Mena Bares LM, Benítez Cantero JM et al. Bile acid malabsorption in patients with chronic diarrhea and Crohn‘s disease. Rev Esp Enferm Dig 2019; 111 (1): 40–45. doi: 10.17235/reed.2018.5376/2017.

28. Walters JR, Johnston IM, Nolan JD et al. The response of patients with bile acid diarrhoea to the farnesoid X receptor agonist obeticholic acid. Aliment Pharmacol Ther 2015; 41 (1): 54–64. doi: 10.1111/apt.12999.

29. Phillips F, Muls AC, Lalji A et al. Are bile acid malabsorption and bile acid diarrhoea important causes of loose stool complicating cancer therapy? Colorectal Dis 2015; 17 (8): 730–734. doi: 10.1111/codi.12932.

30. Jackson A, Lalji A, Kabir M et al. The efficacy of a low-fat diet to manage the symptoms of bile acid malabsorption – outcomes in patients previously treated for cancer. Clin Med (Lond) 2017; 17 (5): 412–418. doi: 10.7861/clin medicine.17-5-412.

31. Gadhok R, Paulon E, Tai C et al. Gastrointestinal consequences of cancer treatment: evaluation of 10 years‘ experience at a tertiary UK centre. Frontline Gastroenterol 2020; 12 (6): 471–477. doi: 10.1136/flgastro-2020-101430.

32. Kohoutova D, Worku D, Aziz H et al. Malignant Melanoma of the Gastrointestinal Tract: Symptoms, Diagnosis, and Current Treatment Options. Cells 2021; 10 (2): 327. doi: 10.3390/ cells10020327.

33. Andreyev HJN, Lalji A, Mohammed K et al. The FOCCUS study: a prospective evaluation of the frequency, severity and treatable causes of gastrointestinal symptoms during and after chemotherapy. Support Care Cancer 2021; 29 (3): 1443–1453. doi: 10.1007/s00520-020-05 610-x.

34. Kohoutova D, Gee C, Fleuret C et al. Bile acid malabsorption as a consequence of cancer treatment: prevalence and management in the national leading centre. UEG J 2021; 9 (8): 207.

35. Bureš J, Kohoutová D, Zavoral M. Gastrointestinální toxicita systémové onkologické imunoterapie. Klin Onkol. In press 2022.

36. Naraev BG, Halland M, Halperin DM et al. Management of Diarrhea in Patients With Carcinoid Syndrome. Pancreas 2019; 48 (8): 961–972. doi: 10.1097/MPA.0000000000001384.

37. Pusceddu S, Rossi RE, Torchio M et al. Differential Diagnosis and Management of Diarrhea in Patients with Neuroendocrine Tumors. J Clin Med 2020; 9 (8): 2468. doi: 10.3390/jcm9082 468.

38. Khan MS, Walter T, Buchanan-Hughes A et al. Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review. World J Gastroenterol 2020; 26 (30): 4537–4556. doi: 10.3748/wjg.v26.i30.4537.

39. Khanna L, Halfdanarson TR, Sonbol MB et al. Bile Acid Malabsorption in Patients with Neuroendocrine Tumors. Dig Dis Sci 2022; 67 (6): 2517–2525. doi: 10.1007/s10620-021-07189-7.

40. Gee C, Fleuret C, Wilson A et al. Bile acid malabsorption as a consequence of cancer treatment: prevalence and management in the national leading centre. Cancers (Basel) 2021; 13 (24): 6213. doi: 10.3390/cancers13246 213.

41. Boyd GS, Merrick MV, Monks R et al. Se-75-labeled bile acid analogs, new radiopharmaceuticals for investigating the enterohepatic circulation. J Nucl Med 1981; 22 (8): 720–725.

42. Westergaard H. Bile Acid malabsorption. Curr Treat Options Gastroenterol 2007; 10 (1): 28–33. doi: 10.1007/s11938-007-0054-7.

43. Vijayvargiya P, Camilleri M, Shin A et al. Methods for diagnosis of bile acid malabsorption in clinical practice. Clin Gastroenterol Hepatol 2013; 11 (10): 1232–1239. doi: 10.1016/j.cgh.2013.04.029.

44. Gupta A, Muls AC, Lalji A et al. Outcomes from treating bile acid malabsorption using a multidisciplinary approach. Support Care Cancer 2015; 23 (10): 2881–2890. doi: 10.1007/s00 520-015-2653-5.

45. Lyutakov I, Ursini F, Penchev P et al. Methods for diagnosing bile acid malabsorption: a systematic review. BMC Gastroenterol 2019; 19 (1): 185. doi: 10.1186/s12876-019-1102-1.

46. Bajor A, Törnblom H, Rudling M et al. Increased colonic bile acid exposure: a relevant factor for symptoms and treatment in IBS. Gut 2015; 64 (1): 84–92. doi: 10.1136/gutjnl-2013-305 965.

47. Jung D, Fantin AC, Scheurer U et al. Human ileal bile acid transporter gene ASBT (SLC10A2) is transactivated by the glucocorticoid receptor. Gut 2004; 53 (1): 78–84. doi: 10.1136/gut.53.1.78.

48. Garbutt JT, Kenney TJ. Effect of cholestyramine on bile acid metabolism in normal man. J Clin Invest 1972; 51 (11): 2781–2789. doi: 10.1172/JCI107100.

49. Sauter GH, Münzing W, von Ritter C et al. Bile acid malabsorption as a cause of chronic diarrhea: diagnostic value of 7alpha-hydroxy-4-cholesten-3-one in serum. Dig Dis Sci 1999; 44 (1): 14–19. doi: 10.1023/a: 1026681512 303.

50. Brydon WG, Nyhlin H, Eastwood MA et al. Serum 7 alpha-hydroxy-4-cholesten-3-one and selenohomocholyltaurine (SeHCAT) whole body retention in the assessment of bile acid induced diarrhoea. Eur J Gastroenterol Hepatol 1996; 8 (2): 117–123. doi: 10.1097/00042737-19960 2000-00005.

51. Gälman C, Angelin B, Rudling M. Bile acid synthesis in humans has a rapid diurnal variation that is asynchronous with cholesterol synthesis. Gastroenterology 2005; 129 (5): 1445–1453. doi: 10.1053/j.gastro.2005.09.009.

52. Aldini R, Roda A, Festi D et al. Diagnostic value of serum primary bile acids in detecting bile acid malabsorption. Gut 1982; 23 (10): 829–834. doi: 10.1136/gut.23.10.829.

53. Yeoh EK, Lui D, Lee NY. The mechanism of diarrhoea resulting from pelvic and abdominal radiotherapy; a prospective study using selenium-75 labelled conjugated bile acid and cobalt-58 labelled cyanocobalamin. Br J Radiol 1984; 57 (684): 1131–1136. doi: 10.1259/0007-1285-57-684-1131.

54. Lauterburg BH, Newcomer AD, Hofmann AF. Clinical value of the bile acid breath test. Evaluation of the Mayo Clinic experience. Mayo Clin Proc 1978; 53 (4): 227–233.

55. Hughes LE, Ford C, Brookes MJ et al. Bile acid diarrhoea: Current and potential methods of diagnosis. Ann Clin Biochem 2021; 58 (1): 22–28. doi: 10.1177/0004563220966139.

56. Arasaradnam RP, Brown S, Forbes A et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut 2018; 67 (8): 1380–1399. doi: 10.1136/gutjnl-2017-315909.

57. Sadowski DC, Camilleri M, Chey WD et al. Canadian Association of Gastroenterology Clinical Practice Guideline on the Management of Bile Acid Diarrhea. Clin Gastroenterol Hepatol 2020; 18 (1): 24–41.e1. doi: 10.1016/j.cgh.2019.08. 062.

58. Bures J, Cyrany J, Kohoutova D et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol 2010; 16 (24): 2978–2990. doi: 10.3748/wjg.v16.i24.2978.

59. Moon C, Zhang W, Sundaram N et al. Drug-induced secretory diarrhea: A role for CFTR. Pharmacol Res 2015; 102: 107–112. doi: 10.1016/ j.phrs.2015.08.024.

60. Keely SJ, Barrett KE. Intestinal secretory mechanisms and diarrhea. Am J Physiol Gastrointest Liver Physiol 2022; 322 (4): G405–G420. doi: 10.1152/ajpgi.00316.2021.

61. Una Cidon E. Vasoactive intestinal peptide secreting tumour: An overview. World J Gastrointest Oncol 2022; 14 (4): 808–819. doi: 10.4251/wjgo.v14.i4.808.

62. Krishnamurthi SS, Macaron C. Management of acute chemotherapy-related diarrhea. UpToDate on-line. Waltham, MA: Wolters Kluwer, 2022. Dostupné: www.uptodate.com (staženo 8.8.2022).

63. Bailly C. Irinotecan: 25 years of cancer treatment. Pharmacol Res 2019; 148: 104398. doi: 10.1016/j.phrs.2019.104398.

64. Wilcox C, Turner J, Green J. Systematic review: the management of chronic diarrhoea due to bile acid malabsorption. Aliment Pharmacol Ther 2014; 39 (9): 923–939. doi: 10.1111/apt. 12684.

65. Mogbojuri OM, Adedapo AA, Abatan MO. Phytochemical screening, safety evaluation, anti-inflammatory and analgesic studies of the leaf extracts of Sterculia tragacantha. J Complement Integr Med 2016; 13 (3): 221–228. doi: 10.1515/jcim-2015-0114.

66. Hvas CL, Ott P, Paine P et al. Obeticholic acid for severe bile acid diarrhea with intestinal failure: A case report and review of the literature. World J Gastroenterol 2018; 24 (21): 2320–2326. doi: 10.3748/wjg.v24.i21.2320.

67. Kårhus ML, Brønden A, Røder ME et al. Remission of Bile Acid Malabsorption Symptoms Following Treatment With the Glucagon-Like Peptide 1 Receptor Agonist Liraglutide. Gastroenterology 2019; 157 (2): 569–571. doi: 10.1053/ j.gastro.2019.04.002.

68. Valencia-Rodríguez A, Aquino-Matus J, Vera-Barajas A et al. New therapeutic options for bile acid malabsorption diarrhea. Ann Transl Med 2019; 7 (22): 695. doi: 10.21037/atm.2019.09. 112.

69. Kårhus ML, Brønden A, Lyng Forman J et al. Protocol for a randomised, double-blinded, placebo-controlled, double-dummy 6-week clinical trial comparing the treatment effects of the glucagon-like peptide 1 receptor agonist liraglutide versus the bile acid sequestrant colesevelam on bile acid malabsorption. BMJ Open 2021; 11 (2): e044711. doi: 10.1136/bmjopen-2020-044 711.

70. Longmire-Cook SJ, Lillienau J, Kim YS et al. Effect of replacement therapy with cholylsarcosine on fat malabsorption associated with severe bile acid malabsorption. Studies in dogs with ileal resection. Dig Dis Sci 1992; 37 (8): 1217–1227. doi: 10.1007/BF01296 563.

71. Kim BT, Kim KM, Kim KN. The Effect of Ursodeoxycholic Acid on Small Intestinal Bacterial Overgrowth in Patients with Functional Dyspepsia: A Pilot Randomized Controlled Trial. Nutrients 2020; 12 (5): 1410. doi: 10.3390/nu12 051410.

72. Muls A, Taylor A, Lalondrelle S et al. A proposed tailored investigational algorithm for women treated for gynaecological cancer with long-term gastrointestinal consequences. Support Care Cancer 2020; 28 (10): 4881–4889. doi: 10.1007/s00520-020-05309-z.

73. BouSaba J, Sannaa W, McKinzie S et al. Impact of Bile Acid Diarrhea in Patients With Diarrhea-Predominant Irritable Bowel Syndrome on Symptoms and Quality of Life. Clin Gastroenterol Hepatol 2021: 20 (9): 2083–2090.e1. doi: 10.1016/j.cgh.2021.11.035.

74. Damsgaard B, Dalby HR, Krogh K et al. Long-term effect of medical treatment of diarrhoea in 377 patients with SeHCAT scan diagnosed bile acid malabsorption from 2003 to 2016; a retrospective study. Aliment Pharmacol Ther 2018; 47 (7): 951–957. doi: 10.1111/apt.14533.

75. Bannaga A, Kelman L, O‘Connor M et al. How bad is bile acid diarrhoea: an online survey of patient-reported symptoms and outcomes. BMJ Open Gastroenterol 2017; 4 (1): e000116. doi: 10.1136/bmjgast-2016-000116.

Další rozsáhlá literatura u autorů.

Štítky
Paediatric gastroenterology Gastroenterology and hepatology Surgery

Článok vyšiel v časopise

Gastroenterology and Hepatology

Číslo 5

2022 Číslo 5
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#