Brydon, W.G.; Ganguly, R.; Ghosh, S.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA9
Academic Journal
Introduction and Aims: Bile acid induced diarrhoea can be of three types: type 1: caused by pathology or resection of terminal ileum; type 2: idiopathic bile acid malabsorption (IBAM) due to increased bile acid pool size or rapid ileal transit, rarely a specific bile acid ileal transport defect; and type 3: non-ileal disease secondary to other conditions such as post-cholecystectomy, lBS, diabetes mellitus, bacterial overgrowth, and chronic pancreatitis. Serum concentration of a hepatic intermediary of bile acid synthesis, 7 α hydroxy-4-cholesten-3one (7HCO) reflects the rate of bile acid synthesis in man and is elevated in clinical conditions associated with bile acid malabsorption (BAM). Serum 7HCO correlates well with SeHCAT test. Methods: Serum HCO was measured on fasting blood sample using HPLC. Standard 7HCO was a kind gift from Professor I. Bjorkhem, Karolinska Institute, Stockholm. Results were calculated as: test peak area X concentration of standard/standard peak area (ng/ mi). Serum 7HCO concentrations > 35 ng/ml were considered to be abnormally raised. A total of 190 patients with watery diarrhoea had serum 7HCO assayed as well as diarrhoea investigated with radiology, endoscopy, celiac serology, pancreatic function tests, and glucose hydrogen breath test. Results: Thirty one out of thirty two patients with ileal Crohn's disease (including 4 resections) had abnormally high 7HCO (type 1 BAM). The median concentration was 158 ng/ml (range 37-590 ng/ml). Twenty six patients with IBAM (type 2 BAM) had a significantly lower (p < 0.00001) 7HCO concentration (median 67.5; range 39-303 ng/ml) than patients with type 1 BAM. Of patients with lBS, post-cholecystectomy, bacterial overgrowth, and chronic pancreatitis, 16/132 had abnormally elevated 7HCO (type 3 BAM). However, the concentration of 7HCO in type 3 BAM (median 46; range 36-71 ng/ml) was significantly lower than type 2 BAM (p < 0.01). Conclusion: The thee types of BAM stratify according to...


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