Nuclear Medicine Imaging and Therapy
Debbie Peet, Emma Chung in Practical Medical Physics, 2021
Bile acid malabsorption is a chronic condition that affects a patient’s digestive system. The process can be measured using a SeHCAT study. SeHCAT (23-seleno-25-homotaurocholic acid, selenium homocholic acid taurine, or tauroselcholic acid) is a drug used to diagnose bile acid malabsorption. The patient is given a low activity 75Se capsule to swallow. The capsule is broken down in the digestive system, and the radiopharmaceutical is actively absorbed by the intestines and re-excreted by the bile duct. Over 7 days, the pharmaceutical is expected to pass around this loop around 35 times, and if malabsorption is present, the level of SeHCAT within the patient will reduce considerably. The amount of SeHCAT in the patient is measured at 4 hours post-administration and again 1 week later.
Gastrointestinal Complications of Diabetes Mellitus
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
Bacterial overgrowth in the small intestine is usually diagnosed by quantitative culture of jejunal aspirates in preference to breath tests after an oral carbohydrate load (reviewed in Ref. 20), a count of more than 105 aerobes or more than 103 per mL anaerobes is diagnostic. Alternatively, one may use the breath excretion of H2 or 14C02 after oral ingestion of simple substrates, such as glucose or d- [,4C]xylose that are metabolized by enteric bacteria. Anemia and low serum folate suggest celiac sprue and mandate a small bowel biopsy. Exocrine pancreatic insufficiency caused by diabetes can be identified by direct pancreatic function testing following intravenous cholecystokinin (CCK) stimulation. It is rarely severe enough to cause steatorrhea. The rare patient with bile acid malabsorption is typically treated with cholestyramine, which may be used as a therapeutic trial, or by slowing small bowel transit pharmacologically.
Nutrition and Gastrointestinal Disorders
David Heber, Zhaoping Li in Primary Care Nutrition, 2017
Malabsorption is a major contributor to weight loss and malnutrition in adult Crohn’s disease patients. Increased gastrointestinal nutrient losses are observed in patients after ileal resection or with bile acid malabsorption (Vitek 2015). Bile acid malabsorption is common in patients, whether the disease is localized in the ileum or not. It leads to malfunction of lipid digestion with steatorrhea, impaired intestinal motility, and significant changes in intestinal microflora. Increased fat in feces could also be a result of a deficit in pancreatic enzyme secretion. Gastric acid- and pancreatic enzyme-impaired secretion have been found in 80% of Crohn’s disease patients.
Consideration of quality of life in the treatment decision-making for patients with advanced gastroenteropancreatic neuroendocrine tumors
Published in Expert Review of Anticancer Therapy, 2023
Boris G. Naraev, Josh Mailman, Thorvardur R. Halfdanarson, Heloisa P. Soares, Erik S. Mittra, Julie Hallet
NET-related diarrhea is one of the most common and impactful symptoms affecting patient QoL [24,62]. There are several symptomatic treatments depending on the underlying pathophysiology: carcinoid syndrome, steatorrhea, short GI transit time, or excessive bile acids. For diarrhea due to carcinoid syndrome, SSA therapy is beneficial [72]. However, some patients with serotonin-producing tumors experience diarrhea that is inadequately controlled by SSAs. In these patients, telotristat ethyl should be considered as add-on therapy based on results from TELESTAR. Patients with poorly controlled diarrhea due to carcinoid syndrome may also benefit from RLT. Chronic SSA use may cause pancreatic insufficiency and steatorrhea [62,73], which can be addressed with pancreatic enzyme therapy and dietary adjustments. Additionally, patients with NETs who have undergone small bowel resection can develop diarrhea resulting from shortened GI transit time or decreased bile acid resorption [74]. Diarrhea resulting from short GI transit time can be improved with dietary adjustments, adjustment of fluid consumption, and certain medications. Bile acid sequestrants can address bile acid malabsorption. More generally, nutritional assessments and dietary modifications have the potential to improve patient symptoms (including but not limited to diarrhea) and QoL [75].
Ileostomy diarrhea: Pathophysiology and management
Published in Baylor University Medical Center Proceedings, 2020
Kyle M. Rowe, Lawrence R. Schiller
Traditional bile acid diarrhea resulting from bile acid malabsorption is not possible in the colectomized patient, as the secretory mechanism resides in the colon. Thus, bile acid binders such as cholestyramine may only serve to worsen fat malabsorption and steatorrhea and should not be prescribed in patients with end ileostomies. In those with larger ileal resections, usually >100 cm, bile acid loss may outpace hepatic production, and steatorrhea due to bile acid deficiency may result. In these cases supplementary bile acid should be considered.19,83 The only bile acid supplement approved by the US Food and Drug Administration (FDA) is cholic acid (Cholbam); however, this drug is approved only for bile acid synthesis disorders and would require off-label use, which would be cost-prohibitive at the current price point. Ox bile supplements can be purchased but are not approved or regulated by the FDA. A reasonable dose would be 1 to 2 g daily taken in divided dose with meals.
The gut virome in Irritable Bowel Syndrome differs from that of controls
Published in Gut Microbes, 2021
S. Coughlan, A. Das, E. O’Herlihy, F. Shanahan, P.W. O’Toole, I.B. Jeffery
Patients with IBS (Rome IV criteria) and control subjects aged 16–70 years and of the same ethnicity and geographic region were recruited to the study. Clinical subtyping of 55 patients with IBS45 included: 21 with constipation (IBS-C), 17 mixed type (IBS-M), and 17 with diarrhea (IBS-D). Exclusion criteria included the use of antibiotics within 6 weeks prior to study enrollment, other chronic illnesses including gastrointestinal diseases, severe psychiatric disease, abdominal surgery other than hernia repair or appendectomy. The inclusion/exclusion criteria for the control population were the same as for the IBS population with the exception of having to fulfill the Rome IV criteria for IBS. Gastrointestinal (GI) symptom history, psychological symptoms, diet, medical history, and medication use were collected on all participants (IBS and controls) and using the Bristol Stool Score, Hospital Anxiety and Depression Scale (HADS)46, and Food Frequency Questionnaire (FFQ).47 IBS-D and IBS-M patients reporting diarrhea as well as a subset of consenting control subjects were assessed for bile acid malabsorption by SeHCAT, a radiolabelled synthetic bile acid which is used to clinical diagnosis of BAM. Ethical approval for the study was granted by the Cork Research Ethics Committee before commencing the study and all participants provided written informed consent. Fresh fecal samples were collected from all participants and these were stored at −80°C within a few hours of the collection until processed for metagenomic sequencing of dsDNA virus-like particles (VLPs). Characteristics of the study population are presented in Table 1.
Related Knowledge Centers
- Bile Acid
- Bile Acid Sequestrant
- Bloating
- Defecation
- Fecal Incontinence
- Malabsorption
- Steatorrhea
- Diarrhea
- Gastrointestinal Disease
- Bristol Stool Scale