Introduction 75Se-HCAT nuclear medicine scanning is used to diagnose Bile Salt Malabsorption (BAM) in patients with chronic diarrhoea. Previous studies suggest that 30–60% of patients with previously unexplained chronic diarrhoea have impaired bile salt absorption (1,2).The aim of this study was to evaluate the prevalence of Bile salt malabsorption among patients with chronic diarrhoea, referred for 75SeHCAT scanning, and to evaluate the outcome of treatment with bile salt sequestrants in these patients.
Methods This was a retrospective audit of patients tested in Nottingham University Hospital in 2011. The patient was given an oral dose of 370 kBq Selenium-75-Tauroselcholic acid, a radiolabelled bile acid analogue. The patient was scanned 7 days later to assess %age of radioactive dose retained. Retention of < 15% was considered to be abnormal. This was further defined as mild (10–15%), moderate (5–10%) and severe ( < 5%).
Results N = 130 patients, medican age 49 yrs, F:M = 1.8:1. The clinical indication for scanning was chronic diarrhoea in all cases (mean 6 bowel actions per day, range 1 to 18). 65 patients (50%) had impaired salt retention. These included 11 with type I disease (Ileal resection or disease), 30 with type 2 disease (idiopathic) and 24 with type 3 disease (miscellaneous disorders eg diabetes or cholecystectomy). Interestingly only 47% of patients with previous terminal ileal resections had a positive 75SeHCAT scan. 47% of those patients with no predisposing factors in their history also had positive scans. 84% of cases with positive test responded to treatment with bile acid sequestrants. The response appeared to be independent from severity of BAM (p = 0.27) or seveity of diarrhoea (p = 0.28). In one third of cases the treatment was discontinued even though clinically effective, most commonly due to poor patient tolerance to its unpleasant taste.
Conclusion The prevalence of BAM is high in patients suffering from chronic diarrhoea, both where a feasible organic precipitant is present (eg previous ileal resection), and where a functional disorder such as IBS was thought to be the likely diagnosis. BAM carries no specific symptoms or markers that can help the physician identify the condition. Bile acid sequestrants are effective, but often not well tolerated. SeHCAT scanning gives objective results and can potentially increase compliance to treatment.
Disclosure of Interest None Declared.
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Marta K. Borghede, Jacob M Schlutter, Jorgen S Agnholt, Lisbet A Christensen, Lars C Gromsen, Jens F Dahlerup. Bile acid malabsorption investigated by selenium-75-homocholic acud taurin scans: Cases and treatment responses to cholestyramin in 298 patients with chronic water diarrhoea. Eur J Intern Med. 2011 Dec; 22(6):e137–40.
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