ReviewMedical science monitor : international medical journal of experimental and clinical research2026
Role of Bile Acid Receptors in Non-Infectious Diarrhea: A Narrative Review.
Review in Medical science monitor : international medical journal of experimental and clinical research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
Non-infectious diarrhea constitutes a prevalent gastrointestinal pathology that severely compromises patient well-being. Its etiology is progressively associated with gut-liver axis dysfunction, although exact molecular pathways remain undefined. This narrative review consolidates the existing research to investigate 5 distinct bile acid-activated receptors: farnesoid X receptor (FXR), Takeda G protein-coupled receptor 5 (TGR5/GPBAR1), pregnane X receptor (PXR), vitamin D receptor (VDR), and retinoid-related orphan receptor gamma t (RORγt). These molecules function as pivotal hubs linking bile acid metabolism, microbial community structure, and intestinal homeostatic balance. Synthesized hepatically and biotransformed by commensal bacteria, bile acids signal through these receptors; specifically, FXR governs bile acid biosynthesis and epithelial barrier strength, TGR5 modulates motility and inflammatory responses, and PXR and VDR attenuate inflammation via nuclear factor-kappa B (NF-kappaB) suppression, while RORγt regulates immunity through T helper 17 (Th17) cell modulation. Perturbations within this axis-manifesting as defective bile acid reclamation, microbiota dysbiosis, or receptor malfunction-compromise intestinal permeability, provoke electrolyte imbalances, and disrupt immune equilibrium, thereby driving bile acid diarrhea, diarrhea-predominant irritable bowel syndrome, and post-surgical diarrheal conditions. Current data suggest FXR activation is essential for driving bile acid diarrhea management, whereas TGR5 overactivation underlies the hypermotility observed in diarrhea-predominant irritable bowel syndrome. Additionally, rifaximin, acting as a PXR agonist, provides therapeutic benefit. This manuscript evaluates bile acid receptor contributions to non-infectious diarrhea, emphasizing the translational potential of targeting these signaling cascades.
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