A new web hub focussed on providing gastroenterologists with the latest information on the diagnosis, treatment and management of patients with gut related disorders.
Kurien M et al. Frontline Gastroenterology 2018;9:92–97.
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Dr. Fermín Mearin-Manrique
Symptoms in this patient point towards a diagnosis of irritable bowel syndrome (IBS)
Differential diagnosis of irritable bowel syndrome
The diagnosis of irritable bowel syndrome (IBS) should be based on the characteristic symptoms outlined in the Rome IV criteria; however, it does not eliminate the need to perform the relevant explorations to confirm the differential diagnosis from other pathologies that can manifest themselves in a similar fashion.
How common is diarrhoea caused by bile acids?
Diarrhoea caused by excess bile acids reaching the colon or bile acid diarrhoea (BAD), which has historically been referred to as bile acid malabsorption (BAM), is not a new disorder.
Diagnostic process in a functional bowel disorders
The complementary tests to perform in the investigation of functional bowel disorders must be chosen in accordance with the individual characteristics of each patient, including age, evolution period of the symptoms, presence of warning signs and findings from physical examinations.
Pathophysiology of bile acid diarrhoea (Part I)
Bile acid diarrhoea (BAD) has been known historically as bile acid malabsorption (BAM).
Inﬂammatory bowel disease: clinical aspects and treatments
Fakhoury M et al. J Inflamm Res 2014;7:113–120.
Pathophysiology of bile acid diarrhoea (Part II)
In a healthy individual, fibroblast growth factor 19 (FGF19) regulates of the size of the bile acid pool by suppressing bile acid synthesis in response to bile acid absorption.
Professor Julian R.F. Walters
Are the current treatments for bile acid diarrhoea effective (BAD), and is it likely that in the future there will be better treatments for BAD?
Current therapies, such as colestyramine and colesevelam, bind and eliminate bile acids from the colon. These drugs prevent the excess bile acids causing watery faeces.
Is bile acid diarrhoea underdiagnosed in patients with Crohn’s disease?
Definitely, yes. Unfortunately for patients with Crohn’s disease, there is a poor relationship between their symptoms and intestinal inflammation, and a considerable proportion of patients’ present symptoms that are not due to the inflammation but rather to bile acid diarrhoea.
Dr Fermín Mearin-Manrique
What is the role of bile acid malabsorption in diarrhoea-predominant irritable bowel syndrome?
In diarrhoea-predominant irritable bowel syndrome, it has been shown that up to 40% of patients are affected by some type of bile acid metabolism disorder, either as malabsorption or with increased bile acid synthesis.
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