Introduction Irritable bowel syndrome is a prevalent disorder with a marked socioeconomic burden. Previous studies support the proposal that a subset of patients with features compatible with diarrhoea predominant IBS (IBS-D) have bile acid malabsorption (BAM). We aimed to perform a systematic review and meta-analysis to assess the prevalence of BAM in patients meeting accepted criteria for IBS-D.
Method MEDLINE and EMBASE were searched up to February 2015. Studies recruiting adults with IBS-D, defined either by the Manning, Kruis, Rome I, II or III criteria and which used 23-seleno-25-homotaurocholic acid (SeHCAT) testing for the assessment of BAM were included. BAM was defined as 7 day SeHCAT retention of <10%. We calculated the rate of BAM and 95% confidence intervals (CI) using a random effects model. The methodological quality of included studies was evaluated using the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2).
Results The search strategy identified 6 relevant studies comprising 908 individuals. The rate of BAM ranged from 16.9% to 35.3%, with an unadjusted rate of 29.3%. The pooled rate according to the random effect model was 28.1% (95% CI 22.6–34%), see Figure 1. There was significant heterogeneity in effect sizes (Q-test X2= 17.9, p < 0.004; I2 72.1%). The type of diagnostic criteria used or study country did not significantly modify the effect.
Conclusion These data provide evidence that in excess of one quarter of patients meeting accepted criteria for IBS-D have BAM. This distinction has implications for the interpretation of previous studies as well as contemporaneous clinical practice and future guideline development.
Disclosure of interest S. Slattery: None Declared, A. Ford: None Declared, Q. Aziz: None Declared, A. Farmer Speaker Bureau of: Almirall.