Obeticholic acid for severe bile acid diarrhea with intestinal failure: A case report and review of the literature
| Autor: | Søren Peter Jørgensen, Jens Frederik Dahlerup, Peter Ott, Christian Lodberg Hvas, Peter Paine, Simon Lal |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Diarrhea Farnesoid X-activated receptor Crohn’s disease Loperamide medicine.medical_specialty medicine.drug_class Receptors Cytoplasmic and Nuclear Case Report Chenodeoxycholic Acid Gastroenterology Bile Acids and Salts 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Crohn Disease Gastrointestinal Agents Malabsorption Syndromes Ileum Internal medicine medicine Humans 030212 general & internal medicine Feedback Physiological Crohn's disease Bile acid Colesevelam business.industry Obeticholic acid Bile acid malabsorption General Medicine medicine.disease Fibroblast Growth Factors Intestinal Absorption Liver chemistry Female 030211 gastroenterology & hepatology Farnesoid X receptor medicine.symptom business medicine.drug |
| Zdroj: | Hvas, C L, Ott, P, Paine, P, Lal, S, Jørgensen, S P & Dahlerup, J F 2018, ' Obeticholic acid for severe bile acid diarrhea with intestinal failure : A case report and review of the literature ', World Journal of Gastroenterology, vol. 24, no. 21, pp. 2320-2326 . https://doi.org/10.3748/wjg.v24.i21.2320 World Journal of Gastroenterology |
| ISSN: | 1007-9327 |
| DOI: | 10.3748/wjg.v24.i21.2320 |
| Popis: | Bile acid diarrhea results from excessive amounts of bile acids entering the colon due to hepatic overexcretion of bile acids or bile acid malabsorption in the terminal ileum. The main therapies include bile acid sequestrants, such as colestyramine and colesevelam, which may be given in combination with the opioid receptor agonist loperamide. Some patients are refractory to conventional treatments. We report the use of the farnesoid X receptor agonist obeticholic acid in a patient with refractory bile acid diarrhea and subsequent intestinal failure. A 32-year-old woman with quiescent colonic Crohn's disease and a normal terminal ileum had been diagnosed with severe bile acid malabsorption and complained of watery diarrhea and fatigue. The diarrhea resulted in hypokalemia and sodium depletion that made her dependent on twice weekly intravenous fluid and electrolyte infusions. Conventional therapies with colestyramine, colesevelam, and loperamide had no effect. Second-line antisecretory therapies with pantoprazole, liraglutide, and octreotide also failed. Third-line treatment with obeticholic acid reduced the number of stools from an average of 13 to an average of 7 per 24 h and improved the patient's quality of life. The fluid and electrolyte balances normalized. The effect was sustained during follow-up for 6 mo with treatment at a daily dosage of 25 mg. The diarrhea worsened shortly after cessation of obeticholic acid. This case report supports the initial report that obeticholic acid may reduce bile acid production and improve symptoms in patients with bile acid diarrhea. |
| Databáze: | OpenAIRE |
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