Fibroblast growth factor 19 in patients with bile acid diarrhoea: a prospective comparison of FGF19 serum assay and SeHCAT retention

@article{Pattni2013FibroblastGF,
  title={Fibroblast growth factor 19 in patients with bile acid diarrhoea: a prospective comparison of FGF19 serum assay and SeHCAT retention},
  author={Sanjeev S. Pattni and W. Gordon Brydon and Tracy K Dew and Ian M. Johnston and Jonathan D. Nolan and Melpakkam Srinivas and Pandurangan Basumani and Karna Dev Bardhan and Julian R. F. Walters},
  journal={Alimentary Pharmacology \& Therapeutics},
  year={2013},
  volume={38}
}
Bile acid diarrhoea is a common, under‐diagnosed cause of chronic watery diarrhoea, responding to specific treatment with bile acid sequestrants. We previously showed patients with bile acid diarrhoea have lower median levels compared with healthy controls, of the ileal hormone fibroblast growth factor 19 (FGF19), which regulates bile acid synthesis. 
The response of patients with bile acid diarrhoea to the farnesoid X receptor agonist obeticholic acid
TLDR
Patients with chronic diarrhoea have reduced levels of the ileal hormone fibroblast growth factor 19 (FGF19), an inhibitory regulator of hepatic bile acid synthesis, secreted in response to farnesoid X receptor (FXR) activation.
Chenodeoxycholic acid stimulated fibroblast growth factor 19 response – a potential biochemical test for bile acid diarrhoea.
TLDR
Bile acid diarrhoea is underdiagnosed and better diagnostic tests are needed, and FGF19 (FGF19) has insufficient diagnostic value, but this may be improved by stimulation.
Commentary: fibroblast growth factor 19 in patients with bile acid diarrhoea
TLDR
In their prospective comparison of serum FGF-19 and 75SeHCAT retention, Pattni et al. confirm the overall relationship between the two measurements, and the inverse relationship (as previously demonstrated by several groups) and reinforce the prior conclusion that reduced ileal F GF-19 secretion is a feature of BAD.
Downregulation of Serum and Distal Ileum Fibroblast Growth Factor19 in Bile Acid Diarrhoea Patients
TLDR
Serum and distal ileum expression of FGF19 significantly decreased in BAD patients, and the suggested clinical ranges for serum FGF 19 < 117.3 pg/ml has high sensitivity and specificity for BAD patients with a normal structural and histological ilesum.
Bile acid diarrhoea and FGF19: new views on diagnosis, pathogenesis and therapy
  • J. Walters
  • Biology, Medicine
    Nature Reviews Gastroenterology &Hepatology
  • 2014
TLDR
Evidence indicates that bile acid diarrhoea accounts for a sizeable proportion of patients who would otherwise be diagnosed with IBS, and the role of the ileal hormone FGF19 in BAD has been strengthened: a prospective clinical study has confirmed low F GF19 levels in BAD, and so a test to measure these levels could be developed for diagnosis.
Effect of cholecystectomy on bile acid diarrhoea biomarkers: A prospective clinical study
TLDR
The effects of cholecystectomy on the plasma biomarkers of bile acid diarrhoea: fibroblast growth factor 19 and 7α‐hydroxy‐4‐cholesten‐3‐one are explored.
Diagnosis of bile acid diarrhoea by fasting and postprandial measurements of fibroblast growth factor 19
TLDR
The difference in serum FGF19 between groups of patients with BAD and diarrhoea controls is amplified postprandially and within each group, the difference between fasting and postpr andial FGF 19 was not statistically significant.
Long‐term effect of medical treatment of diarrhoea in 377 patients with SeHCAT scan diagnosed bile acid malabsorption from 2003 to 2016; a retrospective study
TLDR
Diagnosis is possible by measuring the retention fraction of orally ingested 75Selenium homotaurocholic acid (SeHCAT), which indicates excessive amounts of bile acids entering the colon due to bile Acid malabsorption cause chronic bile acid diarrhoea.
Performance characteristics of serum C4 and FGF19 measurements to exclude the diagnosis of bile acid diarrhoea in IBS‐diarrhoea and functional diarrhoea
The serum biomarkers, elevated 7αC4 (C4) and decreased FGF19, have been proposed as screening tests for bile acid diarrhoea.
The role of bile acids in functional GI disorders
  • R. Appleby, J. Walters
  • Medicine, Biology
    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society
  • 2014
TLDR
Primary bile acid diarrhea remains under‐recognized partly because of the lack of a widely available diagnostic test, and the development of new, directly acting therapeutic agents is still awaited.
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