IRUS Total

Novel associations of bile acid diarrhoea with fatty liver disease and gallstones: a cohort retrospective analysis.

File Description SizeFormat 
BAD_Assn_Manuscript_rev_2_clean.docxAccepted version95.29 kBMicrosoft WordView/Open
e000178.full.pdfPublished version850.44 kBAdobe PDFView/Open
Title: Novel associations of bile acid diarrhoea with fatty liver disease and gallstones: a cohort retrospective analysis.
Authors: Appleby, RN
Nolan, JD
Johnston, ID
Pattni, SS
Fox, J
Walters, JRF
Item Type: Journal Article
Abstract: Background Bile acid diarrhoea (BAD) is a common cause of chronic diarrhoea with a population prevalence of primary BAD around 1%. Previous studies have identified associations with low levels of the ileal hormone fibroblast growth factor 19 (FGF19), obesity and hypertriglyceridaemia. The aim of this study was to identify further associations of BAD. Methods A cohort of patients with chronic diarrhoea who underwent 75selenohomocholic acid taurate (SeHCAT) testing for BAD was further analysed retrospectively. Additional clinical details available from the electronic patient record, including imaging, colonoscopy, chemistry and histopathology reports were used to calculate the prevalence of fatty liver disease, gallstones, colonic neoplasia and microscopic colitis, which was compared for BAD, the primary BAD subset and control patients with diarrhoea. Findings Of 578 patients, 303 (52%) had BAD, defined as a SeHCAT 7d retention value <15%, with 179 (31%) having primary BAD. 425 had an alanine aminotransferase (ALT) recorded, 184 had liver imaging and 176 had both. Overall, SeHCAT values were negatively associated with ALT (rs=−0.19, p<0.0001). Patients with BAD had an OR of 3.1 for an ALT >31 ng/mL with imaging showing fatty liver (p<0.001); similar figures occurred in the primary BAD group. FGF19 was not significantly related to fatty liver but low levels were predictive of ALT >40 IU/L. In 176 subjects with gallbladder imaging, 27% had gallstones, 7% had a prior cholecystectomy and 34% either of these. The median SeHCAT values were lower in those with gallstones (3.8%, p<0.0001), or gallstones/cholecystectomy (7.2%, p<0.001), compared with normal gallbladder imaging (14%). Overall, BAD had an OR of 2.0 for gallstones/cholecystectomy (p<0.05). BAD was not significantly associated with colonic adenoma/carcinoma or with microscopic colitis. Interpretation The diagnosis of BAD is associated with fatty liver disease and with gallstones. The reasons for these associations require further investigation into potential metabolic causes.
Issue Date: 26-Oct-2017
Date of Acceptance: 2-Oct-2017
URI: http://hdl.handle.net/10044/1/51535
DOI: https://dx.doi.org/10.1136/bmjgast-2017-000178
ISSN: 2054-4774
Publisher: BMJ Publishing Group
Journal / Book Title: BMJ Open Gastroenterology
Volume: 4
Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sponsor/Funder: Intercept Pharmaceuticals Inc
Funder's Grant Number: N/A
Publication Status: Published
Article Number: e000178
Appears in Collections:Department of Surgery and Cancer