Biochemical Diagnosis of Bile Acid Diarrhea: Prospective Comparison With the 75Seleno-Taurohomocholic Acid Test

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Christian Borup, Innovational Counsil, Zealand University Hospital, Region Zealand
  • ,
  • Signe Wildt, Innovational Counsil, Zealand University Hospital, Region Zealand
  • ,
  • Jüri Rumessen, Herlev and Gentofte University Hospital
  • ,
  • Jesper Graff, Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Glostrup (Satellite Department on Hvidovre Hospital), Hvidovre, Denmark.
  • ,
  • Pierre Nordine Bouchelouche, Innovational Counsil, Zealand University Hospital, Region Zealand
  • ,
  • Trine Borup Andersen
  • ,
  • Lars Vinter-Jensen
  • ,
  • Anna Zaremba, Aalborg Psychiatric University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
  • ,
  • Søren Peter German Jørgensen
  • Tine Gregersen
  • Camilla Nøjgaard, Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Glostrup (Satellite Department on Hvidovre Hospital), Hvidovre, Denmark.
  • ,
  • Hans Bording Timm, Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Glostrup (Satellite Department on Hvidovre Hospital), Hvidovre, Denmark.
  • ,
  • Dominique Rainteau, 5LPO-BirdLife France, France
  • ,
  • Emilie Gauliard, 5LPO-BirdLife France, France
  • ,
  • Lars Kristian Munck, Innovational Counsil, Zealand University Hospital, Region Zealand

INTRODUCTION: The diagnosis of bile acid diarrhea is often missed because the availability of the seleno-taurohomocholic acid (SeHCAT) test is limited. We aimed to compare the biomarkers 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor 19 (FGF19) with the SeHCAT test.

METHODS: Patients with chronic diarrhea without intestinal resection referred for SeHCAT were prospectively recruited for this diagnostic accuracy study. Blood was sampled at fasting and after a stimulation meal with chenodeoxycholic acid. SeHCAT retention ≤10% defined bile acid diarrhea and >10% defined miscellaneous diarrhea. Receiver operating characteristics (ROC) were analyzed with SeHCAT as the gold standard. www.clinicaltrials.gov (NCT03059537).

RESULTS: Patients with bile acid diarrhea (n = 26) had mean C4 of 30 ng/mL (95% confidence interval: 19-46) vs 8 (7-11; P < 0.001) in the miscellaneous diarrhea group (n = 45). Area under the ROC curve (ROCAUC) for C4 was 0.83 (0.72-0.93). C4 < 15 ng/mL had 85% (74%-96%) negative predictive value; C4 > 48 ng/mL had 82% (59%-100%) positive predictive value. Twenty patients had C4 values 15-48 ng/mL, of whom 11/20 had SeHCAT ≤10%. Median fasting FGF19 was 72 pg/mL (interquartile range: 53-146) vs 119 (84-240) (P = 0.004); ROCAUC was 0.71 (0.58-0.83). Stimulated FGF19 responses did not differ (P = 0.54).

DISCUSSION: We identified C4 thresholds with clinically useful predictive values for the diagnosis of and screening for bile acid diarrhea in patients with chronic watery diarrhea. Further validation of the cutoff values with the placebo-controlled effect of sequestrant therapy is warranted (see Visual Abstract, Supplementary Digital Content 2, http://links.lww.com/AJG/B603).

Original languageEnglish
JournalThe American Journal of Gastroenterology
Volume115
Issue12
Pages (from-to)2086-2094
ISSN0002-9270
DOIs
Publication statusPublished - Dec 2020

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