Chenodeoxycholic acid stimulated fibroblast growth factor 19 response - a potential biochemical test for bile acid diarrhoea.

Autor: Borup C; Department of Internal Medicine, Zealand University Hospital, Køge, Denmark., Wildt S; Department of Internal Medicine, Zealand University Hospital, Køge, Denmark.; Faculty of Health and Human Sciences, University of Copenhagen, Copenhagen, Denmark., Rumessen JJ; Research Unit, Herlev and Gentofte Hospital, Copenhagen, Denmark., Bouchelouche PN; Department of Clinical Biochemistry, Zealand University Hospital, Køge, Denmark., Graff J; Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark., Damgaard M; Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark.; Department of Clinical Physiology and Nuclear Medicine, Zealand University Hospital, Køge, Denmark., McQuitty C; Sorbonne Universités, UPMC Univ Paris 06, Paris-France INSERM-ERL 1157 CNRS UMR 7203 LBM, CHU Saint-Antoine 27, Paris, France., Rainteau D; Sorbonne Universités, UPMC Univ Paris 06, Paris-France INSERM-ERL 1157 CNRS UMR 7203 LBM, CHU Saint-Antoine 27, Paris, France., Munck LK; Department of Internal Medicine, Zealand University Hospital, Køge, Denmark.; Faculty of Health and Human Sciences, University of Copenhagen, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: Alimentary pharmacology & therapeutics [Aliment Pharmacol Ther] 2017 Jun; Vol. 45 (11), pp. 1433-1442. Date of Electronic Publication: 2017 Apr 05.
DOI: 10.1111/apt.14056
Abstrakt: Background: Bile acid diarrhoea is underdiagnosed and better diagnostic tests are needed. Fasting serum fibroblast growth factor-19 (FGF19) has insufficient diagnostic value, but this may be improved by stimulation.
Aim: To explore if an impaired FGF19 response identifies primary bile acid diarrhoea.
Methods: Eight patients with primary bile acid diarrhoea and eight healthy volunteers ingested (i) a meal plus 1250 mg chenodeoxycholic acid (CDCA), (ii) 1250 mg CDCA or (iii) the meal. Blood was sampled at fasting and repeatedly after stimulation. We analysed FGF19 by enzyme-linked immunosorbent assay and bile acids including 7α-hydroxy-4-cholesten-3-one by liquid chromatography-tandem mass spectrometry.
Results: Stimulation with the meal plus CDCA increased median FGF19 in healthy volunteers from fasting 62 pg/mL [interquartile range (IQR): 41-138] to 99 pg/mL (IQR: 67-147; P = 0.012) after 90 min and peaked after 150 min at 313 pg/mL (IQR: 54-512). This response was impaired in primary bile acid diarrhoea patients [fasting 56 pg/mL (IQR: 42-79); 90 min: 48 pg/mL [IQR: 37-63); 150 min: 57 pg/mL (48-198)]. Receiver operating characteristics (ROC AUC ) for fasting FGF19 was 0.55 (P = 0.75) and at 90 min 0.84 (P = 0.02). The difference in FGF19 from fasting to 90 min after the meal plus CDCA separated the groups (ROC AUC 1.0; P = 0.001). 7α-hydroxy-4-cholesten-3-one was elevated in primary bile acid diarrhoea (P = 0.038) and not significantly affected by stimulation.
Conclusions: The FGF19 response following chenodeoxycholic acid plus meal is impaired in primary bile acid diarrhoea. This may provide a biochemical diagnostic test.
(© 2017 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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