Abstract
Simple SummaryBile acid malabsorption is a common albeit a very underdiagnosed gastroenterology condition especially in cancer cohort of patients. Our study, performed at the National leading centre for treatment of cancer, focuses on prevalence and management of bile acid malabsorption in patients reviewed in our specialized clinic. Currently, precise diagnosis and excellent treatments exist for this disease.The aim was to establish prevalence of bile acid malabsorption (BAM) and management in patients who underwent treatment for malignancy. Retrospective evaluation of data in patients seen within six months (August 2019–January 2020) was carried out. Demographic, nuclear medicine (Selenium Homocholic Acid Taurine (SeHCAT) scan result), clinical (previous malignancy, type of intervention (medication, diet), response to intervention) and laboratory (vitamin D, vitamin B12 serum levels) data were searched. In total, 265 consecutive patients were reviewed. Out of those, 87/265 (33%) patients (57 females, 66%) were diagnosed with BAM. Mean age was 59 +/− 12 years. The largest group were females with gynaecological cancer (35), followed by haematology group (15), colorectal/anal (13), prostate (9), upper gastrointestinal cancer (6), another previous malignancy (9). Severe BAM was most common in haematology (10/15; 67%) and gynaecological group (21/35; 60%). Medication and low-fat diet were commenced in 65/87 (75%), medication in 10/87 (11%), diet in 6/87 (7%). Colesevelam was used in 71/75 (95%). Symptoms improved in 74/87 (85%) patients. Vitamin D insufficiency/deficiency was diagnosed in 62/87 (71%), vitamin B12 deficiency in 39/87 (45%). BAM is a common condition in this cohort however treatments are highly effective.
Highlights
Bile acid malabsorption (BAM) was first identified in 1967 [1]
CYP8B1 expression decides about the ratio of cholic acid to chenodeoxycholic acid and CYP7A1 enzyme determines the size of the bile acid pool
Bile acids are released to the duodenum where they play a key role in the solubilization and absorption of the lipids and fat-soluble vitamins [2,3,4,5,6]
Summary
Bile acid malabsorption (BAM) was first identified in 1967 [1]. Primary biliary acids (cholic and chenodeoxycholic acids) are synthesized in 90–95% via the classic pathway in the liver from cholesterol. CYP8B1 and CYP27A1 enzymes further modificate 7α hydroxycholesterol, which generates cholic acid. Production of chenodeoxycholic acid requires CYP27A1 enzyme. CYP8B1 expression decides about the ratio of cholic acid to chenodeoxycholic acid and CYP7A1 enzyme determines the size of the bile acid pool. Primary bile acids are conjugated to taurine or glycine, are secreted to the bile and stored in the gallbladder. Bile acids are released to the duodenum where they play a key role in the solubilization and absorption of the lipids and fat-soluble vitamins [2,3,4,5,6]
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