Thousands suffer from tabooed disease: New method makes it easier to
identify the right treatment

Date:
July 5, 2023
Source:
University of Copenhagen - The Faculty of Health and Medical
Sciences
Summary:
More than 10 urgent visits to the bathroom a day due to diarrhea
can make it virtually impossible to lead a normal life. But new
research can help doctors diagnose bile acid diarrhea and find
the right treatment.


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FULL STORY ==========================================================================
Most people have at some point in their life suffered an intestinal
infection or food poisoning forcing them to stay close to the bathroom. It
is very uncomfortable. Most of the time, though, it passes quickly.

But around 60,000-100,000 Danes suffer from a form of chronic diarrhea
called bile acid malabsorption or bile acid diarrhea.

It is a chronic condition characterised by frequent and sudden diarrhea
more than 10 times a day. Even though the disease is not life-threatening,
it can seriously affect the patient's everyday life, especially their
social life, and be extremely disabling.

"You have to rush to the bathroom several times a day. Therefore,
keeping a job or maintaining social relations can be difficult, and a
lot of people isolate themselves. The disease controls their life,"
says Professor Jesper Bo/je Andersen from the Biotech Research &
Innovation Centre.

He and his research group and clinical cooperation partners at Herlev
and Gentofte Hospital headed by Professor and Consultant Doctor Filip
Krag Knop are responsible for a new study, which provides new ways
of diagnosing bile acid diarrhea and identifying the most effective
treatment for the individual patient.

"A lot of people with chronic diarrhea don't realise that they suffer
from bile acid diarrhea and what has caused it. This is a result of
lack of knowledge among healthcare workers and the relatively complex
and expensive -- and for the patient difficult -- process of diagnosing
the disease," says Filip Krag Knop.

Jesper Bo/je Andersen adds: "We have developed a new concept which may
be used to diagnose the disease based on a simple blood sample. Today, diagnostics involves radiopharmaceuticals, which means that there is a radiation risk. The process is not necessarily dangerous, but unpleasant
and arduous, and not all countries in the world support the method,
including the US." The new method means that doctors should be able to determine whether the patient has bile acid diarrhea based on a simple
blood sample. They focus on molecules known as metabolites in the blood.

"A blood sample contains lots of different metabolites. Right now we are
able to identify almost 1,300 different metabolites, and around a handful
of these can be used to diagnose bile acid diarrhea. The metabolites of
bile acid diarrhea patients form a particular pattern that makes them recognisable," says Jesper Bo/je Andersen.

Which treatment? The researchers analysed blood samples from 50 patients
and they quickly realised that the samples -- and patients -- could be
divided into two groups.

"First, we did not understand why. All the blood samples had been taken
before treatment, typically at the time of diagnosis," says Jesper
Bo/je Andersen.

The patients then participated in a randomised clinical study at
the Center for Clinical Metabolic Research at Herlev and Gentofte
Hospital. Here the doctors studied the effect of two different treatments:
the conventional treatment involving bile acid sequestrant colesevelam
and a new treatment involving liraglutide, which is normally used to
treat type 2 diabetes and severe overweight.

"What is interesting is that the metabolites in the patients' blood
divided them into two groups: one that responds well to colesevelam
and one that responds well to liraglutide. This suggests that we should
be able to say which treatment is the most effective by analysing the
patient's blood at the time of diagnosis," says Jesper Bo/je Andersen.

The clinical study showed that colesevelam treatment eased the bile
acid diarrhea symptoms of 50 per cent of the patients, while liraglutide treatment eased the symptoms of 77 per cent of the patients.

Jesper Bo/je Andersen, Filip Krag Knop and their research groups hope
the new study will benefit the 60,000-100,000 Danes who suffer from bile
acid diarrhea.

The majority of cases of bile acid diarrhea is diagnosed at a very late
stage or never diagnosed at all.

"Around 40 per cent of the patients suffer from this condition for up to
five years before it is diagnosed. Of course, this may be because they
do not realise that it is a disease and that it can be treated. But it
may also be because chronic diarrhea is a tabooed disease," says Filip
Krag Knop.

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========================================================================== Journal Reference:
1. Monika Lewinska, Martin Lund Kaarhus, Anne-Marie Gade Ellegaard,
Manuel
Romero-Go'mez, Rocio I R Macias, Jesper B Andersen, Filip Krag Knop.

Serum lipidome unravels a diagnostic potential in bile acid
diarrhoea.

Gut, 2023; gutjnl-2022-329213 DOI: 10.1136/gutjnl-2022-329213 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2023/07/230705122451.htm

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