Bile acid diarrhoea and intestinal biofilms
Research type
Research Study
Full title
Bile acid diarrhoea and intestinal biofilms
IRAS ID
320842
Contact name
Julian Walters
Contact email
Sponsor organisation
Imperial College Healthcare NHS Trust
Eudract number
2011-003777-28
Duration of Study in the UK
1 years, 1 months, 31 days
Research summary
We propose to investigate whether a new discovery explains the cause of primary bile acid diarrhoea (PBAD). This is a widespread chronic bowel disease estimated to affect over 1% of the population. The causes of PBAD are not fully understood and further knowledge of these is necessary to target specific therapy. Patients with PBAD are often misdiagnosed as diarrhoea-predominant irritable bowel syndrome (IBS-D), especially as the gold standard for diagnosing PBAD, the SeHCAT test, is not always available.
A new finding recently published by our collaborators has important significance for PBAD patients. Biofilms containing specific bacteria were identified in the intestine when these were specifically looked for at colonoscopy. The biofilms were more common in patients with IBS compared with controls. Changes in bacterial species and bile acids were associated with the biofilms. A drawback of this study was that SeHCAT testing was not available to differentiate the PBAD patients from IBS-D. However, in preliminary unpublished work, we have confirmed changes in specific bacteria and bile acids using previously obtained faecal samples from our SeHCAT-diagnosed patients.
We hypothesise that PBAD may result from biofilms in many of these patients. In this proposed study, we will compare the frequency and properties of biofilms in the ileum of SeHCAT-diagnosed PBAD patients, comparing them with SeHCAT-negative IBS-D patients, and look at other associated changes.
We will recruit patients at our hospital who are having routine colonoscopy for chronic diarrhoea. Medical and drug history will be checked, including routine SeHCAT results, and certain preconditions regarding medical treatment met. Additional mucosal biopsy, faecal and blood specimens will be obtained. By establishing a role for biofilms in this defined population, we hope to be able to establish new approaches to diagnosis and treatment for PBAD.
REC name
London - Brent Research Ethics Committee
REC reference
23/LO/0530
Date of REC Opinion
3 Jul 2023
REC opinion
Further Information Favourable Opinion