Introduction Chronic watery diarrhoea is a common referral, with a host of possible aetiologies. To help establish a diagnosis a number of international guidelines have been created, defining diagnostic pathways. Bile acid malabsorption (BAM) is a potential cause, with high prevalence previously demonstrated by our group in patients with Diarrhoea predominant Irritable Bowel Syndrome (D-IBS).1 This study determines the prevalence of BAM and other organic conditions in patients referred with chronic diarrhoea (Group A), with findings compared to our previously published D-IBS cohort (Group B).
Methods A total of 92 consecutive patients referred to a tertiary referral centre with chronic diarrhoea, defined as more than 3 loose or liquid bowel movements a day for at least 4 weeks were evaluated (Group A). Demographic data, subsequent investigations and diagnostic yields of these tests were collected. All patients underwent haematological, biochemical and immunological testing prior to subsequent investigations. Statistical analysis was performed using SPSS with Fisher’s exact test used to compare categorical data.
Results Medical records were identified in 89 of the 92 patients referred (mean age 50 years, range 18–86 years). Of these patients, 23 (26%) had an organic cause for their diarrhoea identified (Table 1), with 6 having dual pathology. Inflammatory bowel disease was the most prevalent condition identified, with the prevalence of BAM being comparable to that seen for coeliac disease (p = 0.72). When evaluating diagnostic yields for BAM in Groups A and B, prevalence was significantly higher in the D-IBS Cohort (42% vs 6%, p < 0.001).
Conclusion In this study organic causes for chronic diarrhoea were identified in 26%. Given that BAM had similar prevalence to coeliac disease in patients with chronic diarrhoea, we would advocate BAM investigations early within the diagnostic pathway.
Disclosure of Interest None Declared.
Kurien M et al. Bile acid malabsorption: an under-investigated differential diagnosis in patients presenting with diarrhoea predominant irritable bowel syndrome type symptoms. Scand J Gastroenterol. 2011 Jul; 46(7–8):818–22