Chunxia Chang1,2, Jingjing Jiang3, Rui Sun3, Shenggen Wang2, Hong Chen4,5. 1. Nanjing Medical University, Nanjing, 211166, Jiangsu, People's Republic of China. 2. Department of Gastroenterology, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, 211102, Jiangsu, People's Republic of China. 3. School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, People's Republic of China. 4. Nanjing Medical University, Nanjing, 211166, Jiangsu, People's Republic of China. njchenhong66@163.com. 5. Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, People's Republic of China. njchenhong66@163.com.
Abstract
BACKGROUND: Bile acid diarrhoea or BAD is a common but little recognised cause of chronic diarrhoea. Few of these patients in China have been diagnosed due to a lack of diagnostic options. AIMS: To clarify the diagnostic value of serum fibroblast growth factor19 (FGF19) in BAD patients. METHODS: We reported on 60 chronic diarrhoea patients and 80 healthy volunteers (HV). Based on the 90th percentile levels of serum 7a-hydroxy-4-cholesten-3-one (C4) of HV, these patients were divided into BAD group (C4 ≥ 90th) and non-bile acid diarrhoea group (NBAD, C4 < 90th). Serum FGF19 in the two clinical groups and HV group were compared, as was distal ileum FGF19 in clinical groups. The diagnostic value of serum FGF19 for BAD was evaluated. RESULTS: The 90th percentile of serum C4 in HV group was 65.87 ng/ml. Serum FGF19 concentrations in BAD group (Median 69.28 pg/ml; n = 23) were significantly lower than those in HV (Median 122.18 pg/ml; n = 80) and NBAD (Median 129.57 pg/ml; n = 29) groups. FGF19 mRNA of the distal ileum in BAD group, was lower than that in NBAD group, P = 0.002. The rate of FGF19 protein low expression of distal ileum in BAD and NBAD group were 78.3% and 48.3%, P = 0.027. Using an ROC curve, statistical analysis yielded a threshold FGF19 concentration of 117.3 pg/ml (AUC, 0.906; 91.3% sensitivity, 79.3% specificity) for a clinical diagnosis of BAD. CONCLUSIONS: Serum and distal ileum expression of FGF19 significantly decreased in BAD patients. The suggested clinical ranges for serum FGF19 < 117.3 pg/ml has high sensitivity and specificity for BAD patients with a normal structural and histological ileum.
BACKGROUND: Bile acid diarrhoea or BAD is a common but little recognised cause of chronic diarrhoea. Few of these patients in China have been diagnosed due to a lack of diagnostic options. AIMS: To clarify the diagnostic value of serum fibroblast growth factor19 (FGF19) in BAD patients. METHODS: We reported on 60 chronic diarrhoea patients and 80 healthy volunteers (HV). Based on the 90th percentile levels of serum 7a-hydroxy-4-cholesten-3-one (C4) of HV, these patients were divided into BAD group (C4 ≥ 90th) and non-bile acid diarrhoea group (NBAD, C4 < 90th). Serum FGF19 in the two clinical groups and HV group were compared, as was distal ileum FGF19 in clinical groups. The diagnostic value of serum FGF19 for BAD was evaluated. RESULTS: The 90th percentile of serum C4 in HV group was 65.87 ng/ml. Serum FGF19 concentrations in BAD group (Median 69.28 pg/ml; n = 23) were significantly lower than those in HV (Median 122.18 pg/ml; n = 80) and NBAD (Median 129.57 pg/ml; n = 29) groups. FGF19 mRNA of the distal ileum in BAD group, was lower than that in NBAD group, P = 0.002. The rate of FGF19 protein low expression of distal ileum in BAD and NBAD group were 78.3% and 48.3%, P = 0.027. Using an ROC curve, statistical analysis yielded a threshold FGF19 concentration of 117.3 pg/ml (AUC, 0.906; 91.3% sensitivity, 79.3% specificity) for a clinical diagnosis of BAD. CONCLUSIONS: Serum and distal ileum expression of FGF19 significantly decreased in BAD patients. The suggested clinical ranges for serum FGF19 < 117.3 pg/ml has high sensitivity and specificity for BAD patients with a normal structural and histological ileum.
Authors: Banny S Wong; Michael Camilleri; Paula Carlson; Sanna McKinzie; Irene Busciglio; Olga Bondar; Roy B Dyer; Jesse Lamsam; Alan R Zinsmeister Journal: Clin Gastroenterol Hepatol Date: 2012-05-18 Impact factor: 11.382