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Role of Plant-Based Medicines for Gallstones
Published in Megh R. Goyal, Preeti Birwal, Durgesh Nandini Chauhan, Herbs, Spices, and Medicinal Plants for Human Gastrointestinal Disorders, 2023
Vivek Kumar, Anju Dhiman, Pooja Chawla, Viney Chawla
Bile is composed of bile salts, cholesterol, and phospholipids, which are present in major proportions and bile pigments are present in minor proportions. In addition to these compounds, lipids, proteins (such as albumin, insulin, haptaglobin, cholecyskinin, lysosomal hydrolase, and amylase) and elements (such as strontium, zinc, sodium, potassium, phosphorus, copper, calcium, manganese, iron, magnesium, molybdenum, and sodium) are also found in the bile. These proteins and elements bind to cholesterol and bile salts, and can affect the crystallization or precipitation of cholesterol in bile. This disturbance in physiochemical balance of cholesterol solubility in bile results in cholelithiasis.
Steatorrhea
Published in Charles Theisler, Adjuvant Medical Care, 2023
Bile salt therapy was effective in a case study where a patient underwent a colectomy, partial ileectomy, and ileostomy for Crohn's disease. There was concern that bile salt therapy would cause or exacerbate severe diarrhea, but this did not happen.3 Oral bile acid supplementation reduced fat excretion markedly, but did not aggravate diarrhea in this case and in another study.5,6
Irritable Bowel Syndrome
Published in Nicole M. Farmer, Andres Victor Ardisson Korat, Cooking for Health and Disease Prevention, 2022
It has been reported that up to 1/3 of people with IBS-D have bile acid malabsorption. Bile is made by the liver, stored in the gall bladder, and used to emulsify fats to help with absorption along the small intestine. Normally, the bile should be reabsorbed in the last section of the small intestine, the terminal ileum. In fact, in a healthy working digestive tract, it is estimated that 95% of the bile is reabsorbed. When this doesn’t happen, the bile acids make their way into the large intestine where they can cause diarrhea by various mechanisms. Removal of, or disease activity in, the terminal ileum can of course cause issues here, but this is less likely a cause of bile acid malabsorption in people with functional bowel disease like IBS. While there are tests for this, usually physicians will prescribe a therapeutic trial of bile acid sequestrants like colestipol to see if this improves the patient’s diarrhea (Camilleri 2015).
Distinct lipid profile in haemolytic anaemia-related gallstones compared with the general gallstone
Published in Annals of Medicine, 2023
Ziqi Wan, Xiaoyin Bai, Chengqing He, Yueyi Zhang, Ying Wang, Kaini Shen, Li Meizi, Qiang Wang, Wu Dongsheng, Yunlu Feng, Aiming Yang
We found that the time to detect gallstones was related to the age at anaemia onset and the stone location. Previous reports indicated that age was an independent risk factor for gallstone-related diseases, but did not make a distinction between cholesterol and pigment stones [1,24,26,27]. The results of our study could, to some extent, indicate that age was also a risk factor for pigment gallstones. Therefore, patients with haemolytic anaemia were recommended an abdominal US if aged older than 50 years, with more frequent follow-up visits. The other independent risk factor was the location of the stones. Stones in the bile duct caused more noticeable and obvious symptoms than those in the gallbladder and hence could be more easily detected. However, our results did not reveal a significant association between female sex, anaemic diseases, or severity of anaemia and the time of detection.
Dietary fiber-based regulation of bile salt hydrolase activity in the gut microbiota and its relevance to human disease
Published in Gut Microbes, 2022
Arthur Kastl, Wenjing Zong, Victoria M. Gershuni, Elliot S. Friedman, Ceylan Tanes, Adoma Boateng, William J. Mitchell, Kathleen O’Connor, Kyle Bittinger, Natalie A. Terry, Christina Bales, Lindsey Albenberg, Gary D. Wu
Bile acids play a fundamentally important role in nutrient absorption through the emulsification and solubilization of fat in the small intestine. Additionally, they regulate mammalian physiology via activation of nuclear hormone and G-protein coupled receptors.1 Amino acid conjugation of bile acids to either glycine or taurine increases their solubility and reduces epithelial passive absorption, thereby preserving high levels of functional bile acids in the small intestine.2 Bacterial bile salt hydrolases (BSHs) are responsible for the rate-limiting step of bile acid deconjugation which is followed by conversion of primary into secondary bile acids via bacterial dehydroxylation.3 While these processes occur normally in the colon, deconjugation of bile acids may occur abnormally in the small intestine. This is clinically relevant in patients with small intestinal bacterial overgrowth (SIBO), where a high deconjugated bile acid load may lead to reduced nutrient absorption and lipid malabsorption.4 SIBO occurs when there is an abnormally high biomass of the gut microbiota in the small intestine which may lead to altered bile acid profile, carbohydrate fermentation, nutrient competition, and epithelial dysfunction. The pathophysiologic effects of SIBO are particularly deleterious in patients with short bowel syndrome (SBS) who are already at risk for poor nutrient assimilation.
Colesevelam – a bile acid sequestrant for treating hypercholesterolemia and improving hyperglycemia
Published in Expert Opinion on Pharmacotherapy, 2022
Oluwayemisi Esan, Adie Viljoen, Anthony S. Wierzbicki
Bile is made by hepatocytes and contains bile acids (BA) as well as cholesterol and is stored in the gallbladder. BAs are secreted into the small intestine to solubilize dietary fats and fat soluble vitamins and by promoting micelle formation, to improve their absorption in the distal ileum. BAs are 95% reabsorbed by specific receptors and transported back to the liver through the enterohepatic circulation for re-secretion while the remaining 5% are excreted in feces [14–16]. BAS reduce resorption of BAs in the ileum at the price of increasing lipids in the colon which is the cause of their adverse effect profile (bloating, diarrhea). In the liver reduced BA concentrations upregulate hepatic cholesterol 7α–hydroxylase (CYP7A1) through the action of the farnesoid-X receptor (FXR) pathway to increase the conversion of cholesterol to BAs. (Figure 1) As a consequence the cholesterol synthesis pathway is upregulated including the rate-limiting enzyme, 3-hydroxy-methyl-glutaryl Coenzyme A reductase and its product mevalonic acid with consequent increased hepatic LDLR expression, increased LDL particles clearance and a reduction in plasma LDL-C [15–17]. The interaction of BAs with FXR and of FXR with liver-X receptor pathways and their combined effects on TG synthesis means that BAS increase TG levels [14–16] .