Bile acid malabsorption in inflammatory bowel disease: assessment by serum markers.
BACKGROUND
Bile acid malabsorption (BAM) is a common feature of Crohn's disease (CD). We aimed to determine whether BAM develops only in patients with a resected distal ileum or if it also occurs in patients who have not undergone surgery for CD.


METHODS
The study included 347 patients with CD or ulcerative colitis (UC) and 119 healthy subjects (controls). BAM was assessed by measurement of serum levels of 7α-hydroxycholest-4-en-3-one (C4) and fibroblast growth factor 19 (FGF19). We surveyed members of the European Crohn's and Colitis Organization and International Organization for the Study of Inflammatory Bowel Disease to collect current information about BAM diagnosis.


RESULTS
The severity of BAM was associated with resection of the distal ileum. Compared with controls, patients who received moderate or extensive ileal resection had significantly increased levels of serum C4 (12 versus 62 versus 243 μg/L, respectively; P < 0.001). However, BAM was also present in a substantial number of the patients with CD who were not treated by surgery who had ileitis or colitis (14% and 11%, respectively). There was an indirect, proportional relationship between levels of C4 and FGF19 (P < 0.001).


CONCLUSIONS
The most severe BAM occurs in CD patients after resection of the distal ileum, but BAM can occur in surgically untreated CD patients, regardless of disease localization. Laboratory tests for BAM should become a part of the algorithm for diagnosis of CD to identify patients who might respond to therapies such as bile acid sequestrants. FGF19 appears to be a reliable marker of BAM.
Department of Clinical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University in Prague, Czech Republic.
Martin
M
Lenicek
Dana
D
Duricova
Viktor
V
Komarek
Bronislava
B
Gabrysova
Milan
M
Lukas
Zdenek
Z
Smerhovsky
Libor
L
Vitek
D000328:Adult; D001647:Bile Acids and Salts / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D002851:Chromatography, High Pressure Liquid; D003093:Colitis, Ulcerative / Q000097:blood / Q000150:complications / Q000601:surgery; D003424:Crohn Disease / Q000097:blood / Q000150:complications / Q000601:surgery; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005346:Fibroblast Growth Factors / Q000097:blood; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000097:blood / Q000150:complications* / Q000601:surgery; D008286:Malabsorption Syndromes / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
D001647:Bile Acids and Salts; D015415:Biomarkers; D008076:Cholesterol, HDL; C117476:FGF19 protein, human; D005346:Fibroblast Growth Factors; D002784:Cholesterol