PMID- 31726982
OWN - NLM
STAT- MEDLINE
DCOM- 20200409
LR  - 20200409
IS  - 1471-230X (Electronic)
IS  - 1471-230X (Linking)
VI  - 19
IP  - 1
DP  - 2019 Nov 14
TI  - Methods for diagnosing bile acid malabsorption: a systematic review.
PG  - 185
LID - 10.1186/s12876-019-1102-1 [doi]
LID - 185
AB  - BACKGROUND: Bile acid malabsorption (BAM) and bile acid-related diarrhea 
      represent an under-recognized cause of chronic diarrhea mainly because of limited 
      guidance on appropriate diagnostic and laboratory tests. We aimed to perform a 
      systematic review of the literature in order to identify and compare the 
      diagnostic accuracy of different diagnostic methods for patients with BAM, 
      despite a proven gold standard test is still lacking. METHODS: A PubMed 
      literature review and a manual search were carried out. Relevant full papers, 
      evaluating the diagnostic accuracy of different methods for BAM, were assessed. 
      Available data were analyzed to estimate the sensitivity and specificity of each 
      published test. RESULTS: Overall, more than one test was considered in published 
      papers on BAM. The search strategy retrieved 574 articles; of these, only 16 were 
      full papers (with a total of 2.332 patients) included in the final review. 
      Specifically, n = 8 studies used (75)Selenium-homotaurocholic-acid-test 
      ((75)SeHCAT) with a < 10% retention threshold; n = 8 studies evaluated fasting 
      serum 7-alpha-hydroxy-4-cholesten-3-one (C4); n = 3 studies involved total fecal bile 
      acid (BA) excretion over 48 h; n = 4 studies assessed fibroblast growth factor 19 
      (FGF19). (75)SeHCAT showed an average sensitivity and specificity of 87.32 and 
      93.2%, respectively, followed by serum C4 (85.2 and 71.1%) and total fecal BA 
      (66.6 and 79.3%). Fasting serum FGF19 had the lowest sensitivity and specificity 
      (63.8 and 72.3%). All the extracted data were associated with substantial 
      heterogeneity. CONCLUSIONS: Our systematic review indicates that (75)SeHCAT has 
      the highest diagnostic accuracy for BAM, followed by serum C4 assay. The 
      diagnostic yield of fecal BA and FGF19 assays is still under investigation. Our 
      review reinforces the need for novel biomarkers aimed to an objective detection 
      of BAM and therefore improving the management of this condition.
FAU - Lyutakov, Ivan
AU  - Lyutakov I
AD  - Clinic of Gastroenterology, University Hospital "Tsaritsa Yoanna - ISUL", Sofia, 
      Bulgaria.
FAU - Ursini, Francesco
AU  - Ursini F
AD  - Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
FAU - Penchev, Plamen
AU  - Penchev P
AD  - Clinic of Gastroenterology, University Hospital "Tsaritsa Yoanna - ISUL", Sofia, 
      Bulgaria.
FAU - Caio, Giacomo
AU  - Caio G
AD  - Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
FAU - Carroccio, Antonio
AU  - Carroccio A
AD  - DiBiMIS University of Palermo, Palermo, Italy.
AD  - Internal Medicine, Giovanni Paolo II Hospital, Sciacca (ASP Agrigento), Sciacca, 
      Italy.
FAU - Volta, Umberto
AU  - Volta U
AD  - Department of Medical and Surgical Sciences, University of Bologna, Bologna, 
      Italy.
FAU - De Giorgio, Roberto
AU  - De Giorgio R
AD  - Department of Medical Sciences, University of Ferrara, Ferrara, Italy. 
      roberto.degiorgio@unife.it.
LA  - eng
PT  - Journal Article
PT  - Systematic Review
DEP - 20191114
PL  - England
TA  - BMC Gastroenterol
JT  - BMC gastroenterology
JID - 100968547
RN  - 0 (Bile Acids and Salts)
RN  - 0 (Biomarkers)
RN  - 5E090O0G3Z (Taurocholic Acid)
RN  - 75018-70-1 (23-seleno-25-homotaurocholic acid)
SB  - IM
MH  - Bile Acids and Salts/*metabolism
MH  - Biomarkers/analysis
MH  - Humans
MH  - Intestinal Reabsorption/physiology
MH  - Malabsorption Syndromes/*diagnosis/metabolism/physiopathology
MH  - Sensitivity and Specificity
MH  - Taurocholic Acid/*analogs & derivatives/analysis
PMC - PMC6854889
OTO - NOTNLM
OT  - Bile acid malabsorption
OT  - Biomarkers
OT  - Chronic diarrhea
OT  - Diagnostic accuracy
COIS- The authors declare that they have no competing interests.
EDAT- 2019/11/16 06:00
MHDA- 2020/04/10 06:00
PMCR- 2019/11/14
CRDT- 2019/11/16 06:00
PHST- 2019/08/07 00:00 [received]
PHST- 2019/10/29 00:00 [accepted]
PHST- 2019/11/16 06:00 [entrez]
PHST- 2019/11/16 06:00 [pubmed]
PHST- 2020/04/10 06:00 [medline]
PHST- 2019/11/14 00:00 [pmc-release]
AID - 10.1186/s12876-019-1102-1 [pii]
AID - 1102 [pii]
AID - 10.1186/s12876-019-1102-1 [doi]
PST - epublish
SO  - BMC Gastroenterol. 2019 Nov 14;19(1):185. doi: 10.1186/s12876-019-1102-1.