Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA.
Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
J Pediatr Gastroenterol Nutr. 2021 Jun 1;72(6):859-865. doi: 10.1097/MPG.0000000000003067.
Excessive fecal bile acids in adults have been associated with diarrhea-predominant irritable bowel syndrome (IBS-D), but their role in pediatric IBS-D is unknown. Serum markers including 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor-19 (FGF-19) were validated in adults to detect bile acid diarrhea (BAD) compared to 48-hour fecal bile acid collection (48FBA). Our aims were to assess fasting serum C4 and FGF-19 and 48FBA in a pediatric population, to compare measurements in IBS-D patients and healthy controls (HC), and to determine the prevalence of BAD among children with IBS-D.
Using a cross-sectional design, 26 patients with IBS-D and 56 HC were recruited in two pediatric tertiary care centers. Fasting serum C4 and FGF-19 and 48FBA were obtained. Participants completed a 7-day bowel diary coinciding with stool collection. Associations were analyzed using Spearman correlations.
Mean age was 14.7 ± 2.5 years (42.3% female) in IBS-D and 12.6 ± 2.4 years (39.3% female) in HC. There was a significant correlation of C4 with 48FBA (r = 0.48, P < 0.05) and an inverse association with FGF-19 (r = -0.43, P < 0.05). No significant differences were noted in C4 (P = 0.32), FGF-19 (P = 0.1), or 48FBA (P = 0.5) between IBS-D and HC groups; however, 20% of IBS-D patients had elevated C4 and 28% had low FGF-19 values.Fecal primary BA was significantly correlated with stool frequency (r = 0.45, P < 0.002).
Correlations of C4 with 48FBA and FGF-19 are confirmed in a pediatric population. Twenty percent of pediatric patients with IBS-D had abnormal fasting serum C4. This serum test could be applied to identify BAD in pediatric IBS-D.
成人中过多的粪便胆汁酸与腹泻为主的肠易激综合征（IBS-D）有关，但它们在儿科 IBS-D 中的作用尚不清楚。血清标志物包括 7α-羟基-4-胆甾烷-3-酮（C4）和成纤维细胞生长因子 19（FGF-19）在成人中被验证可用于检测胆汁酸腹泻（BAD），与 48 小时粪便胆汁酸收集（48FBA）相比。我们的目的是评估儿科人群中的空腹血清 C4 和 FGF-19 以及 48FBA，比较 IBS-D 患者和健康对照者（HC）的测量值，并确定 IBS-D 患儿中 BAD 的患病率。
采用横断面设计，在两个儿科三级保健中心招募了 26 名 IBS-D 患者和 56 名 HC。获得空腹血清 C4 和 FGF-19 以及 48FBA。参与者在粪便收集的同时完成了为期 7 天的排便日记。使用 Spearman 相关分析来分析关联。
IBS-D 组的平均年龄为 14.7±2.5 岁（42.3%为女性），HC 组的平均年龄为 12.6±2.4 岁（39.3%为女性）。C4 与 48FBA 呈显著相关（r=0.48，P<0.05），与 FGF-19 呈负相关（r=-0.43，P<0.05）。IBS-D 组与 HC 组之间的 C4 无显著差异（P=0.32）、FGF-19 无显著差异（P=0.1）或 48FBA 无显著差异（P=0.5）；然而，20%的 IBS-D 患者的 C4 值升高，28%的患者的 FGF-19 值降低。粪便初级胆汁酸与粪便频率显著相关（r=0.45，P<0.002）。
C4 与 48FBA 和 FGF-19 的相关性在儿科人群中得到证实。20%的儿科 IBS-D 患者空腹血清 C4 异常。这种血清检测可用于识别儿科 IBS-D 中的 BAD。
