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

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Term Occurence Count Dictionary
Clostridium difficile colitis 2 infectiousdiseases
Colesevelam 1 infectiousdiseasesdrugs
Colestyramine 1 infectiousdiseasesdrugs
diarrhea 48 infectiousdiseases
loperamide 5 infectiousdiseasesdrugs
tuberculosis 1 infectiousdiseases
vancomycin 3 infectiousdiseasesdrugs

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Select Drug Character Offset Drug Term Instance
Colesevelam 10711 failureDrugMechanism of actionTreatment effectColestyramine (Questran®)Bile salt sequestrantLimited effect Colesevelam (Cholestagel®)Bile salt sequestrantLimited effectPantoprazoleProton pump inhibitorNo effectLoperamide
Colestyramine 10650 patient with severe bile acid diarrhea and intestinal failureDrugMechanism of actionTreatment effect Colestyramine (Questran®)Bile salt sequestrantLimited effectColesevelam (Cholestagel®)Bile salt sequestrantLimited
loperamide 1287 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
loperamide 1904 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
loperamide 4222 sequestrants colestyramine and colesevelam[[3],[7],[8]]. Antisecretory or antimotility drugs such as loperamide and proton pump inhibitors may be added. Some patients with BAD experience an insufficient effect of
loperamide 6364 limited or transient effect, and the diarrhea had been unresponsive to antisecretory treatments such as loperamide and codeine phosphate. At the time of referral, the patient received low-dose 6-mercaptopurine for Crohn’s
loperamide 6543 low-dose 6-mercaptopurine for Crohn’s disease, 625 mg colesevelam three times per day, 2-8 mg of loperamide per day for BAD, 1500 mg of levetiracetam per day for depression, and 400 mg of lamotrigine per day
vancomycin 8005 Shigella species, but a PCR toxin test for Clostridium difficile was positive. A 10-d trial of 125 mg of vancomycin four times per day had a transient effect on the diarrhea, and repeat fecal tests were negative. MRI
vancomycin 12553 test was positive, and a fecal transplant using an anonymous donor was performed following a short vancomycin taper. Subsequently, the mean number of bowel passages per 24 h decreased from a mean of 17 to a mean
vancomycin 20179 test indicating Clostridium difficile colitis.TreatmentClostridium difficile colitis was treated with vancomycin followed by fecal microbiota transplantation. Bile acid diarrhea was refractory to conventional treatments
Select Disease Character Offset Disease Term Instance
Clostridium difficile colitis 20093 biopsies, indicating quiescent Crohn’s disease. Positive Clostridium difficile toxin PCR test indicating Clostridium difficile colitis .TreatmentClostridium difficile colitis was treated with vancomycin followed by fecal microbiota transplantation.
Clostridium difficile colitis 20132 disease. Positive Clostridium difficile toxin PCR test indicating Clostridium difficile colitis.Treatment Clostridium difficile colitis was treated with vancomycin followed by fecal microbiota transplantation. Bile acid diarrhea was refractory
diarrhea 78 Title: World Journal of GastroenterologyObeticholic acid for severe bile acid diarrhea with intestinal failure: A case report and review of the literatureChristian Lodberg HvasDepartment
diarrhea 964 Aarhus C 8000, DenmarkPublication date (ppub): 6/2018Publication date (epub): 6/2018AbstractBile acid diarrhea results from excessive amounts of bile acids entering the colon due to hepatic overexcretion of bile
diarrhea 1466 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
diarrhea 1679 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
diarrhea 1705 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
diarrhea 2339 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
diarrhea 2549 that obeticholic acid may reduce bile acid production and improve symptoms in patients with bile acid diarrhea .Core tip: Bile acid diarrhea develops when excessive amounts of bile acids enter the terminal ileum
diarrhea 2578 reduce bile acid production and improve symptoms in patients with bile acid diarrhea.Core tip: Bile acid diarrhea develops when excessive amounts of bile acids enter the terminal ileum and exceed the intestinal absorptive
diarrhea 2763 exceed the intestinal absorptive capacity. The excess bile acids enter the colon and cause secretory diarrhea . We report a patient with multiple potential causes of chronic diarrhea and suggest a systematic strategy
diarrhea 2835 the colon and cause secretory diarrhea. We report a patient with multiple potential causes of chronic diarrhea and suggest a systematic strategy for the diagnosis and treatment of this condition. Furthermore, we
diarrhea 3002 treatment of this condition. Furthermore, we describe the use of a new treatment for severe bile acid diarrhea , obeticholic acid, which stimulates the farnesoid X receptor of the terminal ileum and increases fibroblast
diarrhea 3237 thereby decreasing hepatic bile acid production via negative feedback.INTRODUCTIONChronic secretory diarrhea causes intestinal losses of water, sodium, and potassium[[1]]. In severe cases, it may negatively affect
diarrhea 3404 potassium[[1]]. In severe cases, it may negatively affect the fluid and electrolyte balance. Chronic secretory diarrhea may be caused by intestinal inflammation, infection, drug side effects or abuse, neuroendocrine tumors,
diarrhea 3528 by intestinal inflammation, infection, drug side effects or abuse, neuroendocrine tumors, functional diarrhea , or bile acid diarrhea (BAD). When no cause is identified, the condition is termed diarrhea-predominant
diarrhea 3551 inflammation, infection, drug side effects or abuse, neuroendocrine tumors, functional diarrhea, or bile acid diarrhea (BAD). When no cause is identified, the condition is termed diarrhea-predominant irritable bowel syndrome
diarrhea 3620 functional diarrhea, or bile acid diarrhea (BAD). When no cause is identified, the condition is termed diarrhea -predominant irritable bowel syndrome (IBS-D)[[2]].BAD occurs when excess amounts of bile acids enter
diarrhea 4855 levels have been reported in patients with primary BAD[[12]] and in patients with Crohn’s disease and diarrhea [[13]]. Obeticholic acid, a potent FXR agonist, stimulates ileal FGF19 production and may thereby decrease
diarrhea 5325 investigations and treatments of a 32-year-old woman with Crohn’s disease who suffered from chronic secretory diarrhea that could be potentially attributed to multiple causal factors. Because no infectious, inflammatory,
diarrhea 5741 with obeticholic acid.CASE REPORTA 32-year-old Caucasian woman was referred to our unit for refractory diarrhea lasting 10 years. She had a 15-year history of recurrent depression and primary tonic-myoclonic epilepsy.
diarrhea 5879 15-year history of recurrent depression and primary tonic-myoclonic epilepsy. Following the onset of diarrhea , she had been diagnosed with colonic Crohn’s disease, and 75selenium homotaurocholic acid test (SeHCAT)
diarrhea 6297 the bile acid sequestrants colestyramine and colesevelam had a limited or transient effect, and the diarrhea had been unresponsive to antisecretory treatments such as loperamide and codeine phosphate. At the time
diarrhea 7106 infliximab, adalimumab, natalizumab, and vedolizumab had been provided before referral and did not affect the diarrhea . Crohn’s disease remission had been verified via a colonoscopy and fecal calprotectin measurement.
diarrhea 8065 was positive. A 10-d trial of 125 mg of vancomycin four times per day had a transient effect on the diarrhea , and repeat fecal tests were negative. MRI of the small bowel and pan-enteric double balloon endoscopy
diarrhea 8422 infection or metabolic disease were normal (Table 1). All medical treatments were reviewed, and because the diarrhea persisted despite conventional treatment, trials of spironolactone, octreotide, and liraglutide were
diarrhea 8883 of 247 nmol/mmol HGB, and an E-MeMP level of 2354 nmol/mmol HGB.Table 1Potential causes of chronic diarrhea and their diagnostic investigations and results in a patient with severe bile acid diarrhea and intestinal
diarrhea 8975 chronic diarrhea and their diagnostic investigations and results in a patient with severe bile acid diarrhea and intestinal failurePotential cause of diarrheaInvestigationsResultsExcess bile acid production with
diarrhea 9025 investigations and results in a patient with severe bile acid diarrhea and intestinal failurePotential cause of diarrhea InvestigationsResultsExcess bile acid production with deficient retentionSeHCAT scintigraphy0 retention,
diarrhea 10462 and synacthen testAll within the normal rangeSeHCAT: Selenium homotaurocholic acid test.Table 2Anti- diarrhea l drug treatments, their mechanisms of action, and their treatment results in a patient with severe bile
diarrhea 10580 treatments, their mechanisms of action, and their treatment results in a patient with severe bile acid diarrhea and intestinal failureDrugMechanism of actionTreatment effectColestyramine (Questran®)Bile salt sequestrantLimited
diarrhea 12098 twice weekly infusions of fluids and electrolytes, but the patient remained underweight, had watery diarrhea , and had a poor quality of life.A trial of obeticholic acid was considered because of the promising
diarrhea 14309 during the initial two months of treatment with 25 mg obeticholic acid once daily for severe bile acid diarrhea with intestinal failure.To examine whether the effects were specific to obeticholic acid and whether
diarrhea 16278 demonstrates the challenges related to the diagnosis and treatment of patients with multifactorial chronic diarrhea . In this patient, a thorough and systematic evaluation of several differential diagnoses was pivotal
diarrhea 16428 systematic evaluation of several differential diagnoses was pivotal for understanding the causes of chronic diarrhea in the presence of a severely disrupted electrolyte balance and intestinal failure. Because the SeHCAT
diarrhea 16711 combination with severe bile acid malabsorption was indicated. In the absence of other causes of chronic diarrhea , we concluded that the patient had severe BAD. Before treatment with obeticholic acid, the patient had
diarrhea 17011 the best of our knowledge, this is the first report of BAD of such severity.For patients with chronic diarrhea , the SeHCAT scintigraphy identifies those with BAD and, hence, a treatable cause of diarrhea[[8],[19],[21]-[23]].
diarrhea 17104 chronic diarrhea, the SeHCAT scintigraphy identifies those with BAD and, hence, a treatable cause of diarrhea [[8],[19],[21]-[23]]. It further helps to tailor the treatment. This investigation therefore remains
diarrhea 17331 in the diagnostic workup and should be considered in patients with Crohn’s disease and unresolved diarrhea [[6]].While this patient was refractory to conventional therapies for diarrhea, she improved both clinically
diarrhea 17409 disease and unresolved diarrhea[[6]].While this patient was refractory to conventional therapies for diarrhea , she improved both clinically and biochemically following treatment with obeticholic acid. This adds
diarrhea 19437 measures and serum FGF19 dynamics.ARTICLE HIGHLIGHTSCase characteristicsA 32-year-old woman with chronic diarrhea that had multiple potential causes including bile acid diarrhea, Crohn’s disease, and medications
diarrhea 19501 characteristicsA 32-year-old woman with chronic diarrhea that had multiple potential causes including bile acid diarrhea , Crohn’s disease, and medications for epilepsy and depression.Clinical diagnosisBile acid diarrhea
diarrhea 19602 diarrhea, Crohn’s disease, and medications for epilepsy and depression.Clinical diagnosisBile acid diarrhea (BAD), diagnosed by selenium homotaurocholic acid test scintigraphy with 0 bile acid retention after
diarrhea 20246 difficile colitis was treated with vancomycin followed by fecal microbiota transplantation. Bile acid diarrhea was refractory to conventional treatments including colestyramine and colesevelam, and oral obeticholic
diarrhea 20696 non-alcoholic steatohepatitis. It was recently reported that obeticholic acid may improve bile acid diarrhea through induction of fibroblast growth factor 19 that inhibits hepatic bile production.Term explanationBAD–bile
diarrhea 20824 of fibroblast growth factor 19 that inhibits hepatic bile production.Term explanationBAD–bile acid diarrhea , resulting from excess hepatic production and/or deficient ileal reabsorption of bile acids, which in
diarrhea 21019 acids, which in turn induces colonic fluid and electrolyte secretion and leads to chronic secretory diarrhea .Experiences and lessonsIn patients with chronic diarrhea, a thorough and systematic diagnostic workup
diarrhea 21076 electrolyte secretion and leads to chronic secretory diarrhea.Experiences and lessonsIn patients with chronic diarrhea , a thorough and systematic diagnostic workup may help to differentiate between potential causes of diarrhea.
diarrhea 21184 diarrhea, a thorough and systematic diagnostic workup may help to differentiate between potential causes of diarrhea . Some patients with bile acid diarrhea are refractory to conventional treatments. Obeticholic acid may
diarrhea 21223 workup may help to differentiate between potential causes of diarrhea. Some patients with bile acid diarrhea are refractory to conventional treatments. Obeticholic acid may be of clinical benefit in these patients
tuberculosis 9872 cultures; PCR for intestinal parasitesNegativeSystemic infectionHIV test; gamma-interferon test for tuberculosis NegativeSmall intestinal bacterial overgrowth (SIBO)Hydrogen breath testNegativeUse of antidepressant

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