A source for healthcare professionals to access the latest data and information on the diagnosis, treatment and management of patients with gut related disorders
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A new web hub focussed on providing gastroenterologists with the latest information on the diagnosis, treatment and management of patients with gut related disorders.
Symptoms of irritable bowel syndrome
Symptoms in this patient point towards a diagnosis of irritable bowel syndrome (IBS)
IBS is characterised by the presence of recurring abdominal pain linked to changes in the pattern of bowel movements, be it constipation, diarrhoea, or both. In accordance with the Rome IV criteria there must be pain at least one day a week, associated with two or more of the following characteristics: defecation, change in frequency of bowel movements, change in stool consistency. Additionally, the criteria must have been met for at least the past three months, and the symptoms must have begun at least six months prior to the diagnosis.
Diarrhoea symptoms in inflammatory bowel disease
We do not know exactly why patients with inflammatory bowel disease (IBD) have clinical symptoms. There is no correlation between endoscopic lesions and the clinical manifestations assessed by the Crohn’s disease activity index.
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. In fact, the first reports of this disease appeared in the 1960s. The diseases in which BAD can be observed are chronic diarrhoea, cholecystectomy, microscopic colitis and irritable bowel syndrome (IBS).
Diagnostic process in 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). In patients with ileal disease or resection, BAD is secondary to malabsorption of bile acids, and this is also the case in certain other gastrointestinal disorders and after cholecystectomy. However, in the case of diarrhoea due to primary or idiopathic BAD, an obvious defect in absorption of bile acids is usually not observed. Instead in these cases, there is often greater bile acid synthesis; this overproduction results in greater concentrations of bile acids entering the colon, leading to diarrhoea.
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. Individuals with bile acid diarrhoea (BAD), either primary, or secondary to ileal dysfunction, produce excess bile acids due to lack of negative feedback from FGF19.
Case studies of bile acid diarrhoea
Bile acid diarrhoea (BAD) is a common but under-recognised cause of chronic functional diarrhoea, accounting for up to a third of patients who meet the criteria for diarrhoea-predominant irritable bowel syndrome (IBS-D).
Some of these patients have true bile acid malabsorption (BAM), usually secondary to other gastrointestinal disorders, but most do not.
Frequency of bile acid diarrhoea in Crohn’s disease
A study was published in 1994 that investigated the referral of patients with Crohn’s disease who did not respond to conventional treatment. The study observed that all patients with a history of ileal resection presented with bile acid diarrhoea (BAD) (historically known as bile acid malabsorption [BAM]), as well as a third of the patients without resection. This finding has been corroborated by a recent study that employed the serum 7α-hydroxycholest-4-en-3-one (C4) test, as opposed to the tauroselcholic (75selenium) acid (SeHCAT) test, in patients with Crohn's disease or ulcerative colitis to assess the severity of BAM.
Functional bowel disorders
Classification of functional bowel disorders
Irritable bowel syndrome (IBS), functional constipation, functional diarrhoea, and functional abdominal bloating/distension are all within the rubric of functional bowel disorders (FBDs). The fundamental change from the Rome III to Rome IV criteria, Rome IV, with regards to FBDs, is that they are not always considered to be individual disorders, it is accepted that they very frequently overlap, and it is at times possible to distinguish them definitively.
Physiology of bile acid diarrhoea
Bile acid diarrhoea (BAD) is a common but under-recognised cause of chronic functional diarrhoea, accounting for up to a third of patients who otherwise would be labelled as diarrhoea-predominant irritable bowel syndrome (IBS-D).
Bile acids normally undergo an enterohepatic circulation. This starts with the hepatic synthesis of bile acids from cholesterol, and then conjugation with glycine or taurine.
19-23 Oct 2019
12-15 Feb 2020
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