Bile Acid Malabsorption As a Consequence of Cancer Treatment: Prevalence and Management in the National Leading Centre

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2021 Dec 24

PMID 34944833

Citations 5

Authors

Caroline Gee

Catherine Fleuret

Ana Wilson

Daniel Levine

Ramy Elhusseiny

Ann Muls

David Cunningham

Darina Kohoutova

Affiliations

Soon will be listed here.

Abstract

The aim was to establish prevalence of bile acid malabsorption (BAM) and management in patients who underwent treatment for malignancy. Retrospective evaluation of data in patients seen within six months (August 2019-January 2020) was carried out. Demographic, nuclear medicine (Selenium Homocholic Acid Taurine (SeHCAT) scan result), clinical (previous malignancy, type of intervention (medication, diet), response to intervention) and laboratory (vitamin D, vitamin B12 serum levels) data were searched. In total, 265 consecutive patients were reviewed. Out of those, 87/265 (33%) patients (57 females, 66%) were diagnosed with BAM. Mean age was 59 +/- 12 years. The largest group were females with gynaecological cancer (35), followed by haematology group (15), colorectal/anal (13), prostate (9), upper gastrointestinal cancer (6), another previous malignancy (9). Severe BAM was most common in haematology (10/15; 67%) and gynaecological group (21/35; 60%). Medication and low-fat diet were commenced in 65/87 (75%), medication in 10/87 (11%), diet in 6/87 (7%). Colesevelam was used in 71/75 (95%). Symptoms improved in 74/87 (85%) patients. Vitamin D insufficiency/deficiency was diagnosed in 62/87 (71%), vitamin B12 deficiency in 39/87 (45%). BAM is a common condition in this cohort however treatments are highly effective.

Citing Articles

Bile's Hidden Weapon: Modulating the Microbiome and Tumor Microenvironment.

Saadh M, Ahmed H, Al-Hussainy A, Kaur I, Kumar A, Chahar M Curr Microbiol. 2024; 82(1):25.

PMID: 39614901 DOI: 10.1007/s00284-024-04004-0.

Gut microbiome and nutrition-related predictors of response to immunotherapy in cancer: making sense of the puzzle.

Hes C, Jagoe R BJC Rep. 2024; 1(1):5.

PMID: 39516566 PMC: 11523987. DOI: 10.1038/s44276-023-00008-8.

Cancer management from a chronic gastrointestinal function perspective.

Wallace A, Phillips-Clarke C, Peiris S, Thiruppathy K Clin Med (Lond). 2023; 23(6):545-548.

PMID: 38065593 PMC: 11298502. DOI: 10.7861/clinmed.2023-GA1.

Dietary Intervention Improves Gastrointestinal Symptoms after Treatment of Cancer in the Pelvic Organs.

Borre M, Fassov J, Poulsen J, Christensen P, Laurberg S, Drewes A J Clin Med. 2023; 12(14).

PMID: 37510881 PMC: 10380860. DOI: 10.3390/jcm12144766.

The functions of lncRNAs in the HPV-negative cervical cancer compared with HPV-positive cervical cancer.

Liu Y, Liu H, Sheng B, Pan S, Wang Z, Zhu X Apoptosis. 2022; 27(9-10):685-696.

PMID: 35980559 DOI: 10.1007/s10495-022-01761-w.

References

Pavlidis P, Powell N, Vincent R, Ehrlich D, Bjarnason I, Hayee B . Systematic review: bile acids and intestinal inflammation-luminal aggressors or regulators of mucosal defence?. Aliment Pharmacol Ther. 2015; 42(7):802-17. DOI: 10.1111/apt.13333. View

BOYD G, Merrick M, Monks R, Thomas I . Se-75-labeled bile acid analogs, new radiopharmaceuticals for investigating the enterohepatic circulation. J Nucl Med. 1981; 22(8):720-5. View

Jackson A, Lalji A, Kabir M, Muls A, Gee C, Vyoral S . The efficacy of a low-fat diet to manage the symptoms of bile acid malabsorption - outcomes in patients previously treated for cancer. Clin Med (Lond). 2017; 17(5):412-418. PMC: 6301937. DOI: 10.7861/clinmedicine.17-5-412. View

Wedlake L . Nutritional strategies to prevent gastrointestinal toxicity during pelvic radiotherapy. Proc Nutr Soc. 2018; 77(4):357-368. DOI: 10.1017/S0029665118000101. View

Walters J, Tasleem A, Omer O, Brydon W, Dew T, le Roux C . A new mechanism for bile acid diarrhea: defective feedback inhibition of bile acid biosynthesis. Clin Gastroenterol Hepatol. 2009; 7(11):1189-94. DOI: 10.1016/j.cgh.2009.04.024. View

Hauer-Jensen M, Denham J, Andreyev H . Radiation enteropathy--pathogenesis, treatment and prevention. Nat Rev Gastroenterol Hepatol. 2014; 11(8):470-9. PMC: 4346191. DOI: 10.1038/nrgastro.2014.46. View

Watson L, Lalji A, Bodla S, Muls A, Andreyev H, Shaw C . Management of bile acid malabsorption using low-fat dietary interventions: a useful strategy applicable to some patients with diarrhoea-predominant irritable bowel syndrome?. Clin Med (Lond). 2015; 15(6):536-40. PMC: 4953254. DOI: 10.7861/clinmedicine.15-6-536. View

Montagnani M, Love M, Rossel P, Dawson P, Qvist P . Absence of dysfunctional ileal sodium-bile acid cotransporter gene mutations in patients with adult-onset idiopathic bile acid malabsorption. Scand J Gastroenterol. 2001; 36(10):1077-80. DOI: 10.1080/003655201750422693. View

Thompson W, Thompson G . Effect of cholestyramine on the absorption of vitamin D3 and calcium. Gut. 1969; 10(9):717-22. PMC: 1552980. DOI: 10.1136/gut.10.9.717. View

10.

Borghede M, Schlutter J, Agnholt J, Christensen L, Gormsen L, Dahlerup J . Bile acid malabsorption investigated by selenium-75-homocholic acid taurine ((75)SeHCAT) scans: causes and treatment responses to cholestyramine in 298 patients with chronic watery diarrhoea. Eur J Intern Med. 2011; 22(6):e137-40. DOI: 10.1016/j.ejim.2011.08.013. View

11.

Pattni S, Walters J . Recent advances in the understanding of bile acid malabsorption. Br Med Bull. 2009; 92:79-93. DOI: 10.1093/bmb/ldp032. View

12.

Stacey R, Green J . Radiation-induced small bowel disease: latest developments and clinical guidance. Ther Adv Chronic Dis. 2014; 5(1):15-29. PMC: 3871275. DOI: 10.1177/2040622313510730. View

13.

Arasaradnam R, Brown S, Forbes A, Fox M, Hungin P, Kelman L . Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut. 2018; 67(8):1380-1399. PMC: 6204957. DOI: 10.1136/gutjnl-2017-315909. View

14.

Reijven P, Soeters P . Vitamin D: A magic bullet or a myth?. Clin Nutr. 2020; 39(9):2663-2674. DOI: 10.1016/j.clnu.2019.12.028. View

15.

Jeffery I, Das A, OHerlihy E, Coughlan S, Cisek K, Moore M . Differences in Fecal Microbiomes and Metabolomes of People With vs Without Irritable Bowel Syndrome and Bile Acid Malabsorption. Gastroenterology. 2019; 158(4):1016-1028.e8. DOI: 10.1053/j.gastro.2019.11.301. View

16.

Russell D . The enzymes, regulation, and genetics of bile acid synthesis. Annu Rev Biochem. 2003; 72:137-74. DOI: 10.1146/annurev.biochem.72.121801.161712. View

17.

Lenicek M, Duricova D, Komarek V, Gabrysova B, Lukas M, Smerhovsky Z . Bile acid malabsorption in inflammatory bowel disease: assessment by serum markers. Inflamm Bowel Dis. 2010; 17(6):1322-7. DOI: 10.1002/ibd.21502. View

18.

Zhou H, Hylemon P . Bile acids are nutrient signaling hormones. Steroids. 2014; 86:62-8. PMC: 4073476. DOI: 10.1016/j.steroids.2014.04.016. View

19.

Wedlake L, AHern R, Russell D, Thomas K, Walters J, Andreyev H . Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2009; 30(7):707-17. DOI: 10.1111/j.1365-2036.2009.04081.x. View

20.

Fani B, Bertani L, Paglianiti I, Fantechi L, De Bortoli N, Costa F . Pros and Cons of the SeHCAT Test in Bile Acid Diarrhea: A More Appropriate Use of an Old Nuclear Medicine Technique. Gastroenterol Res Pract. 2019; 2018:2097359. PMC: 6287164. DOI: 10.1155/2018/2097359. View