Original articleAlimentary tractHigh Prevalence of Idiopathic Bile Acid Diarrhea Among Patients With Diarrhea-Predominant Irritable Bowel Syndrome Based on Rome III Criteria
Section snippets
Participants and Setting
This prospective dual-center study was performed at the Royal Hallamshire Hospital (Sheffield, South Yorkshire, UK) and St. James’s University Hospital (Leeds, West Yorkshire, UK). Both are located in northern England and provide secondary care services to a local population of 500,000 and 800,000 people, respectively. On average, each of the general luminal gastroenterology clinics that took part in this study sees 200 new outpatients per gastroenterologist per year, with diarrhea and
Results
A total of 127 consecutive individuals meeting the Rome III criteria for D-IBS were approached, and 118 (92.9%) participated in the study: 83 individuals from Sheffield and 35 individuals from Leeds. Combined data analysis from both sites showed the mean age of D-IBS patients to be 41.7 years, with 72.9% (n = 86) women, 91.5% (n = 108) Caucasian, with a mean body mass index (BMI) of 27.6. The mean scores for assessments of well-being were as follows: Hospital Anxiety and Depression
Discussion
This study has shown that almost 1 in 4 individuals presenting for secondary care who fulfill Rome III criteria for D-IBS have evidence of idiopathic BAD. Furthermore, in nearly 70% of cases the severity of BAD was within the moderate to severe category, and was associated with significant physical role limitations, compared with patients with only mild BAD. We also found that individuals with BAD had a significantly higher mean BMI compared with patients without BAD. These findings have
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2021, Gastroenterology Clinics of North AmericaCitation Excerpt :Most studies have failed to show a significant association between cytokine levels or cell counts with symptoms.64,67–69 Bile acid diarrhea is reportedly present in approximately 25% of patients with IBS-D.73–75 Bile acids increase secretion, motility, and visceral sensitivity to rectal distention. Bile acid-related visceral hypersensitivity is thought to be due to activation of the farnesoid X receptor on mast cells resulting in increased expression of nerve growth factor and subsequent increased TRPV1 expression on dorsal root ganglion neurons.76
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2021, The Lancet Gastroenterology and HepatologyCitation Excerpt :Patients with a history of cholecystectomy, terminal ileal disease or resection, or pelvic radiotherapy are at risk of bile acid malabsorption and this condition might present with symptoms mimicking IBS-D and functional diarrhoea.52,53 However, there are emerging data to suggest that even in the absence of the aforementioned risk factors, between one in three and one in four patients with symptoms compatible with IBS-D and functional diarrhoea have primary bile acid diarrhoea, in whom most will be categorised as being moderate to severe in nature.54–56 The high prevalence of primary bile acid diarrhoea is seen to a similar extent irrespective of use of the Rome III or IV criteria.56
Conflicts of interest These authors disclose the following: David Sanders and Alexander Ford have received grant support and speakers’ fees from GE Healthcare. The remaining authors disclose no conflicts.
Funding Supported by GE Healthcare.