Bile acid malabsorption in inflammatory bowel disease: Assessment by serum markers

• Published in: Inflammatory bowel diseases Vol. 17; no. 6; pp. 1322 - 1327
• Main Authors: Lenicek, Martin, Duricova, Dana, Komarek, Viktor, Gabrysova, Bronislava, Lukas, Milan, Smerhovsky, Zdenek, Vitek, Libor
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.06.2011
• Subjects: 7α‐hydroxycholest‐4‐en‐3‐one; Adult; Algorithms; bile acid malabsorption; Bile acids; Bile Acids and Salts - metabolism; Biomarkers - blood; Case-Control Studies; Cholesterol - blood; Cholesterol, HDL - blood; Chromatography, High Pressure Liquid; Colitis, Ulcerative - blood; Colitis, Ulcerative - complications; Colitis, Ulcerative - surgery; Crohn Disease - blood; Crohn Disease - complications; Crohn Disease - surgery; Crohn's disease; Enzyme-Linked Immunosorbent Assay; Female; Fibroblast growth factor; Fibroblast Growth Factors - blood; Humans; ileal disease; Ileitis; Ileum; inflammatory bowel disease; Inflammatory bowel diseases; Inflammatory Bowel Diseases - blood; Inflammatory Bowel Diseases - complications; Inflammatory Bowel Diseases - surgery; International organizations; Intestine; Malabsorption; Malabsorption Syndromes - blood; Malabsorption Syndromes - complications; Male; Middle Aged; Serum levels; Severity of Illness Index; Surgery; Ulcerative colitis
• ISSN: 1078-0998; 1536-4844; 1536-4844
• DOI: 10.1002/ibd.21502

Background: Bile acid malabsorption (BAM) is a common feature of Crohn's disease (CD). We aimed to determine whether BAM develops only in patients with a resected distal ileum or if it also occurs in patients who have not undergone surgery for CD. Methods: The study included 347 patients with CD or ulcerative colitis (UC) and 119 healthy subjects (controls). BAM was assessed by measurement of serum levels of 7α‐hydroxycholest‐4‐en‐3‐one (C4) and fibroblast growth factor 19 (FGF19). We surveyed members of the European Crohn's and Colitis Organization and International Organization for the Study of Inflammatory Bowel Disease to collect current information about BAM diagnosis. Results: The severity of BAM was associated with resection of the distal ileum. Compared with controls, patients who received moderate or extensive ileal resection had significantly increased levels of serum C4 (12 versus 62 versus 243 μg/L, respectively; P < 0.001). However, BAM was also present in a substantial number of the patients with CD who were not treated by surgery who had ileitis or colitis (14% and 11%, respectively). There was an indirect, proportional relationship between levels of C4 and FGF19 (P < 0.001). Conclusions: The most severe BAM occurs in CD patients after resection of the distal ileum, but BAM can occur in surgically untreated CD patients, regardless of disease localization. Laboratory tests for BAM should become a part of the algorithm for diagnosis of CD to identify patients who might respond to therapies such as bile acid sequestrants. FGF19 appears to be a reliable marker of BAM. (Inflamm Bowel Dis 2011;)