Chronic Diarrhea Helped With New Class Of Drugs

Researchers at the Imperial College London may have discovered a solution to chronic diarrhea-what's otherwise referred to as bile acid diarrhea (BAD) and oftentimes mistaken for irritable bowel syndrome (IBS) by many doctors throughout the world. As statistics show that about one in 100 adults in western countries are affected by this major health concern, researchers have uncovered a drug that could provide extensive relief for those in need.

Study findings revealed that the drug obeticholic acid (OCA) worked for patients dealing with the health issue. OCA is the first in a new class of drugs, farnesoid X receptor (FXR) agonists, and the response of the patients to OCA shows abnormalities in the system it targets that may be critical for the condition.

"Many doctors are totally unaware of bile acid diarrhoea, but it's more common than Crohn's disease and ulcerative colitis. When patients are correctly diagnosed, there are specific treatments that can help them, but many people find these current drugs are unpalatable," said professor Julian Walters, from the Department of Medicine at the college, in a news release. "The condition often has a serious impact on patients' work and social lives, causing people to have up to ten watery bowel movements a day, often for many months, with an urgent need to go to avoid accidental incontinence."

BAD is primarily caused by excessive secretion of bile acids that are part of digestion. When secreted into the intestine from the gall bladder, the bile acids are normally absorbed in the ileum--a part of the small intestine. However, in patients with BAD, excess bile passes into the colon and causes watery diarrhea.

A hormone produced in the ileum, FGF19, regulates the production of bile acids in the liver, and previous studies found that patients with BAD have low levels of FGF19. OCA targets the receptors in the ileum that stimulate the production of FGF19.

For the study, researchers tested OCA in three groups: 10 with primary BAD, where the intestine is otherwise healthy; 10 with secondary BAD, where malabsorption can occur as a result of another disease such as Crohn's; and eight with other causes of chronic diarrhoea, who served as a control group.

The patients who were treated at Imperial College Healthcare NHS Trust were asked to record their symptoms in a diary for two weeks before starting OCA treatment for two weeks taking the drug daily and two weeks afterwards. They also had blood tests at the start and end fo the OCA treatment period.

Findings revealed that symptoms improved with OCA treatments in the primary BAD patients and some secondary BAD patients. However, this was not the case in those with chronic diarrhea.

More information regarding the findings can be seen via the journal Alimentary Pharmacology and Therapeutics.