Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Gut. 2015 Jan;64(1):84-92. doi: 10.1136/gutjnl-2013-305965. Epub 2014 Apr 12.
Bile acids may play a role in the pathogenesis of IBS. We investigated the potential effects of bile acids entering the colon and its role in the symptom pattern in IBS.
We measured 75Se-labelled homocholic acid-taurine (75SeHCAT) retention, and serum levels of 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor (FGF) 19 in patients with IBS (n=141) and control subjects (75SeHCAT n=29; C4 and FGF19 n=435). In patients with IBS stool frequency and form, as well as GI symptom severity were registered, and in a proportion of patients colonic transit time and rectal sensitivity were measured (n=66). An 8-week open-label treatment with colestipol was offered to patients with 75SeHCAT <20%, and the effect of treatment was evaluated with IBS severity scoring system and adequate relief of IBS symptoms.
Compared with controls, patients with IBS had lower 75SeHCAT values (p=0.005), higher C4c levels (C4 corrected for cholesterol) (p<0.001), but similar FGF19 levels. Abnormal 75SeHCAT retention (<10%) was seen in 18% of patients, whereas 23% had elevated C4c levels. Patients with IBS with 75SeHCAT retention <10% had more frequent stools, accelerated colonic transit time, rectal hyposensitivity, a higher body mass index, higher C4c and lower FGF19 levels. Colestipol treatment improved IBS symptoms (IBS severity scoring system 220±109 vs. 277±106; p<0.01), and 15/27 patients fulfilled criteria for treatment response (adequate relief ≥50% of weeks 5-8).
Increased colonic bile acid exposure influences bowel habit and colonic transit time in patients with IBS. A high response rate to open label treatment with colestipol supports this, but placebo-controlled studies are warranted.
胆汁酸可能在 IBS 的发病机制中发挥作用。我们研究了胆汁酸进入结肠及其在 IBS 症状模式中的作用。
我们测量了 IBS 患者（n=141）和对照组（75SeHCAT n=29；C4 和 FGF19 n=435）的 75Se 标记同型胆酸牛磺酸（75SeHCAT）保留率、血清 7α-羟基-4-胆甾烯-3-酮（C4）和成纤维细胞生长因子（FGF）19 水平。在 IBS 患者中，记录了粪便频率和形式以及 GI 症状严重程度，并在一部分患者中测量了结肠通过时间和直肠敏感性（n=66）。对于 75SeHCAT<20%的患者，提供了为期 8 周的考来烯胺开放标签治疗，并使用 IBS 严重程度评分系统和 IBS 症状充分缓解来评估治疗效果。
与对照组相比，IBS 患者的 75SeHCAT 值较低（p=0.005），C4c 水平较高（校正胆固醇后）（p<0.001），但 FGF19 水平相似。18%的患者存在异常的 75SeHCAT 保留率（<10%），而 23%的患者存在 C4c 水平升高。75SeHCAT 保留率<10%的 IBS 患者粪便更频繁，结肠通过时间加速，直肠低敏，体重指数更高，C4c 水平更高，FGF19 水平更低。考来烯胺治疗改善了 IBS 症状（IBS 严重程度评分系统 220±109 与 277±106；p<0.01），15/27 名患者符合治疗反应标准（第 5-8 周的缓解率≥50%）。
增加的结肠胆汁酸暴露影响 IBS 患者的排便习惯和结肠通过时间。高比例的患者对考来烯胺的开放标签治疗有反应支持了这一点，但需要安慰剂对照研究。
