Introduction SeHCAT scanning is not commonly performed in patients with chronic diarrhoea, despite British Society of Gastroenterology guidelines advocating its use. Greater awareness of bile acid diarrhoea (BAD) may increase uptake of testing. We aimed to assess the prevalence of BAD in consecutive patients with chronic diarrhoea undergoing SeHCAT scanning, and to identify factors predicting a positive result.
Methods A retrospective review was undertaken over 6 years at Leeds Teaching Hospitals. A standardised scanning protocol was adopted. Medical records were reviewed to obtain information regarding previous cholecystectomy, terminal ileal (TI) Crohn's disease (CD), TI resection or right hemicolectomy for CD, right hemicolectomy for other reasons, radiation exposure, enteric infection and microscopic colitis. BAD was defined as present when SeHCAT retention was <15% (mild <15%, moderate <10%, and severe <5%), and classified according to underlying aetiology (type I secondary to TI resection or right hemicolectomy, type II idiopathic, and type III secondary to all other causes). Presence of bloating and abdominal pain were used to define IBS.
Results 163 (51.4%) of 317 patients had some degree of BAD. A greater proportion of patients with a positive test had undergone cholecystectomy (29.4% vs 13.9%, p=0.001), TI resection for CD (17.8% vs 1.9%, p<0.001) or TI resection or right hemicolectomy for other reasons (8.6% vs 1.9%, p=0.009). Radiotherapy, enteric infection, or microscopic colitis were not associated with BAD. 54 (37%) of 145 individuals with no obvious risk factors had some degree of BAD, with 17 (32.1%) having severe BAD. Fewer individuals with BAD reported bloating (16.0% vs 25.0%, p=0.05), and fewer met criteria for IBS (40.5% vs 52.6%, p=0.03). More patients with severe disease had previous right hemicolectomy or TI resection for CD (32.1%, p<0.001). A greater proportion of those with mild BAD fulfilled criteria for IBS, compared with those with moderate or severe BAD (65.9% vs 46.3% and 24.7%, p<0.001).
Conclusion BAD is common in patients with chronic diarrhoea. Prior surgery is a strong predictor of a positive test, and may negate need for testing. However, among those with no proposed risk factors, yield of testing was almost 40%. The prevalence of BAD in patients with chronic diarrhoea is high, and SeHCAT scanning is a worthwhile diagnostic strategy.
Competing interests None declared.
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