Introduction Bile acid diarrhoea (BAD) is a recognised cause of chronic diarrhoea, however detection remains sub-optimal. Knowledge of factors predictive of BAD could help improve detection. This study evaluates factors predictive of BAD (7 day SeHCAT retention <10%) and determines long treatment outcomes in those instigated on medical therapy.
Methods 515 patients underwent a SeHCAT test in a University hospital (2001–2012). Of these 41% (210/515) had evidence of BAD. Demographic data, clinical and biochemical indices were collected in all patients tested. Binary logistic regression was then used to determine factors predictive of BAD. 107 of the 210 (51%) patients with BAD were diagnosed between 2001–2009 and commenced on bile acid sequestrants.1 In March 2013, these patients (n = 107) were re-contacted and reassessed either in a gastroenterology clinic or via telephone consultation, determining their bowel frequency, current symptoms, response to bile acid sequestrants and whether on continuing treatment. Comparisons were made in pre and post treatment variables using a paired sample t-test.
Results Binary Logistic regression identified only terminal ileal Crohn’s, terminal ileal resection, previous small bowel surgery and cholecystectomy as predictors of BAD (p < 0.0001). With regards to follow up, 54% (58/107) of patients (median age 57 years, range 29–74 years, 42 females) were contactable and agreeable to follow up assessment. The mean time since diagnosis of BAM was 7.1 years, with a mean result of 3.6% at diagnosis. 38% (22/58) of patients were still on bile acid sequestrants at follow up, with 28% using alternative anti-diarrhoeal agents. In those who were on bile acid sequestrant therapy, mean stool frequency decreased from 7.3 stools per day to 3.9 (p < 0.0001). The 34% (20/58) of patients not receiving medical therapy had no change in their daily bowel frequency (7.0 vs 5.35, p = 0.40). The main reason for discontinuing medical therapy in this group was poor tolerability of the prescribed bile acid sequestrant (Colestyramine/ Colestipol). Crohn’s disease was the only alternative diagnosis established in 10% (2/20), accounting for potential persisting symptoms.
Conclusion This is the first longitudinal study to assess patients with BAM and identifies factors predictive of this condition. Our findings suggest BAM is a chronic condition, which best improves with bile acid sequestrants. Given the problems with tolerability of older bile acid sequestrants, consideration should be given to Colsevalam, which may have a better tolerability profile.
Reference 1 Kurien M, et al. Bile acid malabsorption: An under-investigated differential diagnosis in patients presenting with diarrhea predominant irritable bowel syndrome type symptoms. Scand J Gastroenterol 2011 Jul;46(7-8):818–22
Disclosure of Interest None Declared.
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