Methods for diagnosing bile acid malabsorption: a systematic review
Abstract 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 a...
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| Format: | Article |
| Language: | English |
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BMC
2019-11-01
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| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12876-019-1102-1 |
| _version_ | 1811296138391715840 |
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| author | Ivan Lyutakov Francesco Ursini Plamen Penchev Giacomo Caio Antonio Carroccio Umberto Volta Roberto De Giorgio |
| author_facet | Ivan Lyutakov Francesco Ursini Plamen Penchev Giacomo Caio Antonio Carroccio Umberto Volta Roberto De Giorgio |
| author_sort | Ivan Lyutakov |
| collection | DOAJ |
| description | Abstract 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 75Selenium-homotaurocholic-acid-test (75SeHCAT) with a < 10% retention threshold; n = 8 studies evaluated fasting serum 7-α-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). 75SeHCAT 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 75SeHCAT 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. |
| first_indexed | 2024-04-13T05:44:08Z |
| format | Article |
| id | doaj.art-8bf70f5399994bbfb3168573b70d632e |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-04-13T05:44:08Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-8bf70f5399994bbfb3168573b70d632e2022-12-22T03:00:00ZengBMCBMC Gastroenterology1471-230X2019-11-0119111110.1186/s12876-019-1102-1Methods for diagnosing bile acid malabsorption: a systematic reviewIvan Lyutakov0Francesco Ursini1Plamen Penchev2Giacomo Caio3Antonio Carroccio4Umberto Volta5Roberto De Giorgio6Clinic of Gastroenterology, University Hospital “Tsaritsa Yoanna – ISUL”Department of Medical Sciences, University of FerraraClinic of Gastroenterology, University Hospital “Tsaritsa Yoanna – ISUL”Department of Medical Sciences, University of FerraraDiBiMIS University of PalermoDepartment of Medical and Surgical Sciences, University of BolognaDepartment of Medical Sciences, University of FerraraAbstract 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 75Selenium-homotaurocholic-acid-test (75SeHCAT) with a < 10% retention threshold; n = 8 studies evaluated fasting serum 7-α-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). 75SeHCAT 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 75SeHCAT 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.http://link.springer.com/article/10.1186/s12876-019-1102-1Bile acid malabsorptionBiomarkersChronic diarrheaDiagnostic accuracy |
| spellingShingle | Ivan Lyutakov Francesco Ursini Plamen Penchev Giacomo Caio Antonio Carroccio Umberto Volta Roberto De Giorgio Methods for diagnosing bile acid malabsorption: a systematic review BMC Gastroenterology Bile acid malabsorption Biomarkers Chronic diarrhea Diagnostic accuracy |
| title | Methods for diagnosing bile acid malabsorption: a systematic review |
| title_full | Methods for diagnosing bile acid malabsorption: a systematic review |
| title_fullStr | Methods for diagnosing bile acid malabsorption: a systematic review |
| title_full_unstemmed | Methods for diagnosing bile acid malabsorption: a systematic review |
| title_short | Methods for diagnosing bile acid malabsorption: a systematic review |
| title_sort | methods for diagnosing bile acid malabsorption a systematic review |
| topic | Bile acid malabsorption Biomarkers Chronic diarrhea Diagnostic accuracy |
| url | http://link.springer.com/article/10.1186/s12876-019-1102-1 |
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