We speak of chronic diarrhea when the stools are liquid and abundant (more than 200 grams per day) for more than a month. Or, according to the WHO (World Health Organization), when they are more than three times a day and/or liquid. Recently, researchers published a study in the British Medical Journal to improve the management of this disorder, particularly when it is due to bile acid malabsorption.
A blood profile to find the right medicine for biliary diarrhea
Blood samples were taken from patients who suffered from chronic diarrhoea. They revealed that the origin of this diarrhea was due to a problem with the absorption of bile acids, which aim to increase the intestinal absorption of cholesterol and regulate its excretion.
So, two treatments, originally used for other disorders, were tested to try to solve these diarrheas: a treatment usually used against type 2 diabetes by stimulating the secretion of insulin in a “glucose-dependent” way (liraglutide) , and another allowing to fix bile acids in the intestine (colesevelam).
After examining the metabolites present in the blood of the patients, the guinea pigs were divided into two groups. And both drugs have been tested. Liraglutide was 77% effective in reducing diarrhea, and colesevelam 50%. Depending on their blood profile, some responded better to one or the other..
And this is where the discovery is interesting: with a simple blood test, we could therefore be able to correctly adapt the treatment against certain types of chronic diarrhea. As a reminder, there are many symptomatic treatments, but theFrench Association for Continuing Medical Education in Hepato-Gastro-Enterology stresses that it is best to tackle what causes the diarrhoea.
In parallel with “bile acid sequestrants”, of which colesevelam is a part, she develops the other options available to date: “Loperamide has an anti-secretory action and slows down transit. The diet restricting long-chain dietary triglycerides and replacing these with medium-chain triglycerides (Liprocil and Ceres) is indicated for protein-losing enteropathy of lymphatic origin.”
Sources: French Association for Continuing Medical Education in Hepato-Gastro-Enterology, BMJ
