Newswise — Many individuals experience an intestinal infection or food poisoning at some stage of their lives, compelling them to remain near the restroom. This situation is highly uncomfortable, yet it usually resolves swiftly.
But around 60,000-100,000 Danes suffer from a form of chronic diarrhoea called bile acid malabsorption or bile acid diarrhoea.
It is a persistent ailment marked by frequent and abrupt diarrhea, occurring over 10 times daily. While the condition is not life-threatening, it can significantly impact the patient's daily existence, particularly their social life, and cause significant disability.
"Having to urgently visit the restroom multiple times throughout the day becomes necessary. Consequently, maintaining employment or nurturing social connections can prove challenging, leading many individuals to isolate themselves. The illness exerts a dominating influence over their lives," remarks Professor Jesper Bøje Andersen from the Biotech Research & Innovation Centre.
Professor Jesper Bøje Andersen, along with his research group and clinical collaboration partners at Herlev and Gentofte Hospital, led by Professor and Consultant Doctor Filip Krag Knop, are spearheading a recent study. This study introduces innovative methods for diagnosing bile acid diarrhea and determining the most suitable treatment for each individual patient.
Filip Krag Knop highlights, "Many individuals experiencing chronic diarrhea remain unaware that they are afflicted by bile acid diarrhea and its underlying causes. This lack of awareness stems from limited knowledge among healthcare professionals and the relatively intricate, costly, and challenging diagnostic procedures for the disease that patients have to undergo."
Jesper Bøje Andersen adds:
"We have devised a novel approach that enables the diagnosis of the disease through a straightforward blood sample. Currently, diagnostic methods involve the use of radiopharmaceuticals, posing a radiation risk. The existing process is not necessarily perilous but rather unpleasant and laborious, and not all countries, including the US, endorse this method," explains Professor Filip Krag Knop.
The novel method allows doctors to ascertain the presence of bile acid diarrhea in patients by analyzing a simple blood sample. The focus of their analysis lies in examining specific molecules, known as metabolites, present in the blood.
Jesper Bøje Andersen explains, "A blood sample encompasses numerous diverse metabolites. Presently, we can identify nearly 1,300 distinct metabolites, and among them, a few can be utilized for diagnosing bile acid diarrhea. The metabolites found in patients with bile acid diarrhea exhibit a distinct pattern that allows for their recognition."
Which treatment?
The scientists examined blood samples from 50 patients and promptly discovered that the samples - along with the patients - could be classified into two categories.
"Initially, we were perplexed. The reason remained unclear. All blood samples were collected pre-treatment, usually at the point of diagnosis," Jesper Bøje Andersen explained.
Subsequently, the individuals enrolled in a randomized clinical trial at the Center for Clinical Metabolic Research at Herlev and Gentofte Hospital. During the trial, physicians investigated the impact of two distinct interventions: the conventional method utilizing the bile acid sequestrant colesevelam, and a novel approach employing liraglutide, typically prescribed for managing type 2 diabetes and obesity.
"The intriguing aspect is that the metabolites present in the patients' blood distinguished them into two categories: those who exhibit a favorable response to colesevelam and those who demonstrate a positive response to liraglutide. This implies that by analyzing the patient's blood at the time of diagnosis, we should be able to determine the most effective treatment," Jesper Bøje Andersen explained.
The clinical investigation revealed that colesevelam treatment alleviated the symptoms of bile acid diarrhea in 50 percent of the patients, whereas liraglutide treatment improved the symptoms in 77 percent of the patients.
Jesper Bøje Andersen, Filip Krag Knop, and their respective research teams aspire that this new study will bring benefits to the estimated 60,000-100,000 individuals in Denmark who experience bile acid diarrhea.
The majority of cases of bile acid diarrhoea is diagnosed at a very late stage or never diagnosed at all.
"Approximately 40 percent of the patients endure this condition for up to five years before receiving a diagnosis. This may be attributed to a lack of awareness regarding the nature of the disease and its treatability. Alternatively, it could be due to the social stigma surrounding chronic diarrhea," Filip Krag Knop explained.
About bile acid diarrhoea
When we consume high-fat food, the gallbladder releases bile acid to aid in the absorption of fat and fat-soluble vitamins from the food. Normally, about 98 percent of the bile acid is absorbed by the small intestine and transported back to the liver through the bloodstream. However, if the body produces or releases excessive amounts of bile acid, or if the bile acid is not properly reabsorbed by the blood, a significant portion will accumulate in the large intestine. This accumulation leads to irritation of the intestinal lining, reduced fluid levels in the intestines, and increased intestinal contractions, all of which contribute to the symptoms associated with bile acid diarrhea.
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