COMMENTARY

Inflammatory bowel disease

Do steroids ameliorate bile acid malabsorption in Crohn’s disease?

R S Kwon, M C Carey

Department of Medicine, Harvard Medical School, Division of Gastroenterology, Brigham and Women’s Hospital and Harvard Digestive Diseases Center, Boston, MA, USA

Correspondence to:
Correspondence to:
Dr M C Carey
Brigham and Women’s Hospital, Division of Gastroenterology, 75 Francis Street, Boston, MA, 02115, USA; mccarey@rics.bwh.harvard.edu

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Steroids may partially restore impaired bile salt absorption in Crohn’s disease patients, highlighting a new modus operandi for steroids as their beneficial effects have traditionally been attributed to immunomodulatory effects alone

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Keywords: Crohn’s disease; bile acids; gene regulation; intestinal transport; steroid receptors

The first 150 words of the full text of this article appear below.

Steroids are among the mainstays of medical therapy for Crohn’s disease but may lead to unfavourable long term complications. Recently, budesonide has been shown to be effective in inducing remission in mild to moderate disease while undergoing less systemic absorption compared with other corticosteroids.¹ It is hypothesised that steroids exert their salutary effect through an immunomodulatory action on the small bowel mucosa.² In this issue of Gut, Jung and colleagues³ shed light on the possibility of another potentially beneficial effect of steroid therapy—namely, the partial restoration of impaired bile salt absorption in Crohn’s patients with distal ileal involvement [see page 78].

The integrity of the enterohepatic circulation of bile salts is dependent on active uptake from the ileum, which is mediated by SLC10A2, known previously as the apical sodium dependent bile acid transporter (ASBT).⁴ Given the malady’s proclivity for the distal ileum, one of . . . [Full text of this article]

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Relevant Article

Human ileal bile acid transporter gene ASBT (SLC10A2) is transactivated by the glucocorticoid receptor

D Jung, A C Fantin, U Scheurer, M Fried, and G A Kullak-Ublick
Gut 2004 53: 78-84. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Dawson, P. A., Lan, T., Rao, A. (2009). Bile acid transporters. J. Lipid Res. 50: 2340-2357 [Abstract] [Full Text]