Introduction Bile Acid Malabsorption (BAM) causes chronic diarrhoea and can be confirmed using SeHCAT retention. There are limited data on the use of SeHCAT for diagnosis and management of BAM, but its use is supported in dated BSG guidelines. Recently, NICE recommended that SeHCAT use in irritable bowel syndrome (IBS) and Crohn’s disease should be restricted.
Method A prospective study evaluated SeHCAT usage across the UK. This resulted in a dataset with more than 200 variables, capturing centre and patient-level information. Eligible data from 38 centres and 1,036 patients were entered into a validated management system.
Results Mean age was 50 years (6–89), 65% female. Prior colonoscopy was recorded in 76%, blood tests in 89%. Only 27% of patients had an IBS diagnosis reported. Overall, the centre-defined ‘normal’ retention was seen in 47% of cases, and ‘abnormal’ retention in 43%, the rest being considered borderline. Suspected Type 1 (BAM secondary to ileal resection/disease) was the smallest group (14%). Of these, 83% had Crohn’s disease and 64% had an ileal resection. SeHCAT retention was predictably low: mean 9%, (SD 13%), median 2%. The largest group (44%) with suspected Type 2 (idiopathic/primary BAM), had a mean retention of 21% (SD 17%), median 18%. In suspected Type 3 (41%; BAM secondary to various gastrointestinal diseases) mean retention was 22% (SD 20%), median 17%. Of these 34% were post-cholecystectomy and 12% were diabetic.
Conclusion SeHCAT in the UK is used widely. However protocols are variable and reliable cut-offs for clinical significance remain ill-defined. Dated BSG algorithms and recent NICE guidelines are not currently being consistently followed. Clinicians suspecting BAM predominantly consider this as primary bile acid diarrhoea or as secondary to other disorders. Analysis of the detailed clinical data acquired in this study will assist in the design of future definitive prospective research.
Disclosure of interest None Declared.