The pathophysiology of bile acid diarrhoea: differences in the colonic microbiome, metabolome and bile acids

• Published in: Scientific reports Vol. 10; no. 1; p. 20436
• Main Authors: Sagar, Nidhi M., Duboc, Henri, Kay, Gemma L., Alam, Mohammad T., Wicaksono, Alfian N., Covington, James A., Quince, Christopher, Kokkorou, Margarita, Svolos, Vaios, Palmieri, Lola J., Gerasimidis, Konstantinos, Walters, Julian R. F., Arasaradnam, Ramesh P.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 24-11-2020; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4020; 692/4020/1503; 692/4020/2741; 692/4020/2741/2135; 692/4020/2741/520; Acids; Bacteria - classification; Bacteria - genetics; Bacteria - isolation & purification; Bile; Bile acids; Bile Acids and Salts - analysis; Bile Acids and Salts - blood; Bile Acids and Salts - metabolism; Case-Control Studies; Diarrhea; Diarrhea - metabolism; Diarrhea - microbiology; Diarrhea - pathology; DNA, Bacterial - genetics; DNA, Ribosomal - genetics; Dysbacteriosis; Fatty Acids, Volatile - analysis; Feces; Feces - chemistry; Feces - microbiology; Gastrointestinal Microbiome; Homeostasis; Humanities and Social Sciences; Humans; Intestinal microflora; Intestine; Irritable bowel syndrome; Metabolites; Metabolomics - methods; Microbiomes; Microbiota; multidisciplinary; Organic compounds; Pathophysiology; Phylogeny; Propionic acid; RNA, Ribosomal, 16S - genetics; rRNA 16S; Science; Science (multidisciplinary); Sequence Analysis, DNA - methods; Steatorrhea - metabolism; Steatorrhea - microbiology; Steatorrhea - pathology; VOCs; Volatile organic compounds; Volatile Organic Compounds - urine
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-77374-7

Bile acid diarrhoea (BAD) is a common disorder resulting from increased loss of bile acids (BAs), overlapping irritable bowel syndrome with diarrhoea (IBS-D). The gut microbiota metabolises primary BAs to secondary BAs, with differing impacts on metabolism and homeostasis. The aim of this study was to profile the microbiome, metabolic products and bile acids in BAD. Patients with BAD diagnosed by SeHCAT testing, were compared with other IBS-D patients, and healthy controls. Faecal 16S ribosomal RNA gene analysis was undertaken. Faecal short chain fatty acid (SCFA) and urinary volatile organic compounds (VOCs) were measured. BAs were quantified in serum and faeces. Faecal bacterial diversity was significantly reduced in patients with BAD. Several taxa were enriched compared to IBS-D. SCFA amounts differed in BAD, controls and IBS-D, with significantly more propionate in BAD. Separation of VOC profiles was evident, but the greatest discrimination was between IBS-D and controls. Unconjugated and primary BA in serum and faeces were significantly higher in BAD. The faecal percentage primary BA was inversely related to SeHCAT. BAD produces dysbiosis, with metabolite differences, including VOC, SCFA and primary BAs when compared to IBS-D. These findings provide new mechanistic insights into the pathophysiology of BAD.