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Obeticholic acid for severe bile acid diarrhea with intestinal failure:A case report and review of the literature

World Journal of Gastroenterology 2018年第21期24卷 2320-2326页

作者： christian lodberg hvas Peter Ott Peter Paine Simon Lal Soren Peter Jorgensen Jens Frederik Dahlerup Department of Hepatology and Gastroenterology Aarhus University HospitalAarhus C 8000Denmark Department of Gastroenterology Salford Royal NHS Foundation TrustSalfordManchester M6 8HDUnited Kingdom

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 24h 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.

关键词： Bile acid malabsorption Diarrhea Farnesoid X-activated receptor Crohn’s disease

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Deep hyperammonemic hepatic encephalopathy precipitated by fecal microbiota transplantation for fulminant Clostridioides difficile infection

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Gastroenterology Report 2022年第1期10卷 612-614页

作者： Lotte Lindgreen Eriksen Simon Mark Dahl Baunwall Peter Lykke Eriksen Kirstine Petrea Bak-Fredslund Jens Erik Nielsen Jens Frederik Dahlerup Karen Louise Thomsen Hendrik Vilstrup christian lodberg hvas Department of Hepatology and Gastroenterology Aarhus University HospitalAarhus NDenmark Department of Hepatology and Gastroenterology Randers Regional HospitalRandersDenmark Department of Radiology Aarhus University HospitalAarhus NDenmark

Introduction Fecal microbiota transplantation(FMT)is highly effective and potentially life-saving for recurrent Clostridioides difficile infection(CDI)[1].Recent pilot trials also reported the use of FMT to revert hepatic encephalopathy(HE)in patients with decompensated liver cirrhosis without infectious colitis[2,3].Intestinal microbiota-driven hyperammonemia is central to HE development and most treatments aim to reduce ammonia levels by modulating the intestinal ***,FMT might lead to increased intestinal ammonia production,as we describe here.

关键词： hepatic infection encephalopathy

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