J Clin Invest: The Clostridium difficile-rich microbiome promotes excessive excretion of fecal bile acid in patients with irritable bowel syndrome.

Excessive fecal bile acid (BA) is considered one of the mechanisms of diarrhea-based irritable bowel syndrome (IBS-D).
However, the factors that lead to BA excretion are not yet clear.
given the importance of the gut microbiome in BA metabolism, we speculate that intestinal microbiome disorders may lead to excessive BA excretion in IBS-D.
study included 290 IBS-D patients and 89 healthy volunteers for BA-related metabolic and metagenome analysis.
found that 24.5% of IBS-D patients showed excessive total BA excretion and changes in BA-converted bacteria in feces.
it is worth noting that the increase in Clostridium spores (e.g. Clostridium spores) was positively correlated with fecal BAs and serum 7 alpha-hydroxy-4-bile-steroidene-3-ketone (C4), but negatively correlated with the concentration of serum fibroblast growth factor 19 (FGF19).
, colonies rich in IBS-D fecal microbiome or Clostridium difficile enhanced serum C4 and liver conjugate BAs in mice, but reduced expression of reintestinal FGF19.
use vancomycin to inhibit clostridium spores can have the opposite result.
BAs derived from Clostridium spores inhibited the expression of intestinal FGF19 both in vitro and in the body.
in general, this study shows that the Clostridium difficile-rich microbiome promotes excessive excretion of BA in IBS-D patients.
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