Markers of Bile Acid Metabolism in Pediatric Diarrhea Predominant Irritable Bowel Syndrome and Healthy Controls

Beate C. Beinvogl, Mhd Louai Manini, Michael Camilleri, Leslie J. Donato, William Scott Harmsen, Imad Absah, Elizabeth Burch, Neil L. Schechter, Samuel Nurko

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: Excessive fecal bile acids in adults have been associated with diarrhea-predominant irritable bowel syndrome (IBS-D), but their role in pediatric IBS-D is unknown. Serum markers including 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor-19 (FGF-19) were validated in adults to detect bile acid diarrhea (BAD) compared to 48-hour fecal bile acid collection (48FBA). Our aims were to assess fasting serum C4 and FGF-19 and 48FBA in a pediatric population, to compare measurements in IBS-D patients and healthy controls (HC), and to determine the prevalence of BAD among children with IBS-D. Methods: Using a cross-sectional design, 26 patients with IBS-D and 56 HC were recruited in two pediatric tertiary care centers. Fasting serum C4 and FGF-19 and 48FBA were obtained. Participants completed a 7-day bowel diary coinciding with stool collection. Associations were analyzed using Spearman correlations. Results: Mean age was 14.7 ± 2.5 years (42.3% female) in IBS-D and 12.6 ± 2.4 years (39.3% female) in HC. There was a significant correlation of C4 with 48FBA (r = 0.48, P < 0.05) and an inverse association with FGF-19 (r = -0.43, P < 0.05). No significant differences were noted in C4 (P = 0.32), FGF-19 (P = 0.1), or 48FBA (P = 0.5) between IBS-D and HC groups; however, 20% of IBS-D patients had elevated C4 and 28% had low FGF-19 values. Fecal primary BA was significantly correlated with stool frequency (r = 0.45, P < 0.002). Conclusions: Correlations of C4 with 48FBA and FGF-19 are confirmed in a pediatric population. Twenty percent of pediatric patients with IBS-D had abnormal fasting serum C4. This serum test could be applied to identify BAD in pediatric IBS-D.

Original languageEnglish (US)
Pages (from-to)859-865
Number of pages7
JournalJournal of pediatric gastroenterology and nutrition
Issue number6
StatePublished - Jun 1 2021


  • 7α-hydroxy-4-cholesten-3-one
  • fecal bile acids
  • fibroblast growth factor-19

ASJC Scopus subject areas

  • Gastroenterology
  • Pediatrics, Perinatology, and Child Health


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