Clinical Chemistry, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Ann Clin Biochem. 2021 Jan;58(1):22-28. doi: 10.1177/0004563220966139. Epub 2020 Oct 28.
Chronic diarrhoea is common and mostly due to diarrhoea predominant irritable bowel syndrome. Diarrhoea predominant irritable bowel syndrome affects about 11% of the population; however, up to a third of these patients actually have bile acid diarrhoea. There are, therefore, more than one million sufferers of bile acid diarrhoea in the UK. Bile acid diarrhoea is caused by small bowel malabsorption of bile acids and the increased bile acids in the large intestine cause diarrhoea. Once diagnosed, the treatment of bile acid diarrhoea is simple and effective. Bile acid diarrhoea , however, is often not diagnosed because of a lack of easily available and reliable diagnostic methods. In the United Kingdom, the radiolabelled 23-seleno-25-homotaurocholic acid test is the gold-standard method of diagnosis. 23-seleno-25-homotaurocholic acid test, however, is expensive, inconvenient to the patient, involves radiation exposure and has limited availability. As such, a laboratory biomarker is desirable. This review briefly discusses the pathophysiology and management of bile acid diarrhoea and critically evaluates methods for its diagnosis, including serum 7α-hydroxy-4-cholesten-3-one, faecal bile acid measurement, serum fibroblast growth factor 19, urine-2-propanol, and the C-glycocholate breath and stool test.
慢性腹泻很常见，主要是由于腹泻为主的肠易激综合征。腹泻为主的肠易激综合征影响约 11%的人口；然而，这些患者中有多达三分之一实际上患有胆汁酸腹泻。因此，在英国有超过 100 万的胆汁酸腹泻患者。胆汁酸腹泻是由小肠对胆汁酸吸收不良引起的，而大肠中增加的胆汁酸会导致腹泻。一旦确诊，胆汁酸腹泻的治疗方法简单有效。然而，由于缺乏易于获得和可靠的诊断方法，胆汁酸腹泻往往未被诊断。在英国，放射性标记的 23-硒-25-同牛磺胆酸试验是诊断的金标准方法。然而，23-硒-25-同牛磺胆酸试验价格昂贵，对患者不方便，涉及辐射，且可用性有限。因此，需要一种实验室生物标志物。这篇综述简要讨论了胆汁酸腹泻的病理生理学和管理，并批判性地评估了其诊断方法，包括血清 7α-羟基-4-胆甾烷-3-酮、粪便胆汁酸测量、血清成纤维细胞生长因子 19、尿-2-丙醇和 C-糖胆酸呼气和粪便试验。
