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Chronic diarrhea, bile acids, and Clostridia
Julian R.F. Walters, Julian R. Marchesi
Julian R.F. Walters, Julian R. Marchesi
Published December 9, 2019
Citation Information: J Clin Invest. 2020;130(1):77-79. https://doi.org/10.1172/JCI133117.
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Commentary

Chronic diarrhea, bile acids, and Clostridia

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Abstract

Excessive fecal bile acid (BA) loss causes symptoms in a large proportion of people diagnosed with irritable bowel syndrome with diarrhea, a common functional bowel disorder. This BA diarrhea (BAD) results from increased hepatic synthesis of BAs, with impaired negative feedback regulation by the ileal hormone fibroblast growth factor 19 (FGF19). In this issue of the JCI, Zhao et al. investigated BA metabolism, including fecal BAs, serum BAs, and FGF19, in patients and controls. They identified associations between fecal bacterial BA metabolism and specific microbiota, especially Clostridium scindens. These findings have been tested in a mouse model using microbiota transplants and antibiotic treatment. This group of organisms has potential as a biomarker for BAD and to be a target for therapy.

Authors

Julian R.F. Walters, Julian R. Marchesi

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Figure 1

Factors contributing to BA diarrhea.

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Factors contributing to BA diarrhea.
The key physiological steps in BA m...
The key physiological steps in BA metabolism produce or interact with specific factors that can contribute to the pathophysiology of altered BA metabolism and thus result in chronic diarrhea. Bacterial species influence various BA proportions (gold arrows with varying width) and influence FGF19 signaling (purple arrow).
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