Sciumè Giusi Desirè, Berti Ginevra, Lambiase Christian, Paglianiti Italia, Villanacci Vincenzo, Rettura Francesco, Grosso Antonio, Ricchiuti Angelo, Bortoli Nicola de, Usai Satta Paolo, Bassotti Gabrio, Bellini Massimo
Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010 Pisa, Italy.
Nuclear Medicine Unit, Department of New Technologies and Translational Research in Medicine and Surgery, University of Pisa, 56010 Pisa, Italy.
J Clin Med. 2023 Sep 5;12(18):5787. doi: 10.3390/jcm12185787.
Irritable bowel syndrome with predominant diarrhea (IBS-D) and functional diarrhea (FD) are disorders of gut-brain interaction characterized by recurring symptoms which have a serious impact on the patient's quality of life. Their pathophysiology is far from being completely understood. In IBS-D growing evidence suggests that bile acid malabsorption (BAM) could be present in up to 30% of patients. Microscopic colitis (MC) is a well-known cause of watery diarrhea and some patients, at first, can be diagnosed as IBS-D or FD. Both BAM and MC are often responsible for the lack of response to conventional treatments in patients labelled as "refractory". Moreover, because BAM and MC are not mutually exclusive, and can be found in the same patient, they should always be considered in the diagnostic workout when a specific treatment for BAM or MC is unsatisfactory. In the present review the possible shared pathogenetic mechanisms between BAM and MC are discussed highlighting how MC can induce a secondary BAM. Moreover, a brief overview of the current literature regarding the prevalence of their association is provided.
以腹泻为主型肠易激综合征（IBS-D）和功能性腹泻（FD）是肠脑互动障碍，其特征为反复出现的症状，对患者生活质量有严重影响。它们的病理生理学远未被完全理解。在IBS-D中，越来越多的证据表明，高达30%的患者可能存在胆汁酸吸收不良（BAM）。显微镜下结肠炎（MC）是水样腹泻的一个已知原因，一些患者最初可能被诊断为IBS-D或FD。BAM和MC通常都是被标记为“难治性”的患者对传统治疗无反应的原因。此外，由于BAM和MC并非相互排斥，且可在同一患者中发现，当针对BAM或MC的特异性治疗效果不佳时，在诊断过程中应始终考虑到它们。在本综述中，讨论了BAM和MC之间可能的共同致病机制，强调了MC如何诱导继发性BAM。此外，还提供了关于它们关联患病率的当前文献的简要概述。
