Introduction Chronic diarrhoea is a common condition which may result from a number of different disorders, including bile acid diarrhoea. Primary bile acid diarrhoea is found in around 36% of patients with functional diarrhoea or diarrhoea-predominant irritable bowel syndrome, but is often undiagnosed. We hypothesised that a positive diagnosis of bile acid diarrhoea would reduce the need in these patients for subsequent investigations to look for alternative diagnoses.
Method Patients previously recruited to a prospective study of chronic diarrhoea, who had SeHCAT testing and subsequent follow-up at our institution, were identified and their electronic records were reviewed. The numbers of defined investigations undertaken between 3 months and 5 years after SeHCAT were compared.
Results 90 patients were identified with primary bile acid diarrhoea (SeHCAT <15%, n=36) or with idiopathic diarrhoea (SeHCAT >15%, n=54). Follow-up had been performed on 29 and 39 respectively. There was no difference between these groups in the number of previous investigations or the date of the last contact. In the follow-up period, there was no significant difference in the proportion of these patients who had undergone endoscopic procedures (gastroscopy, colonoscopy, sigmoidoscopy). However there was a higher proportion of patients in the SeHCAT-negative group who had undergone other investigations including imaging, physiological tests and blood tests (p=0.037). Use of cross-sectional imaging was significantly higher in this group (p=0.015) with greater proportions having CT (0.44 vs. 0.10) and MRI (0.26 vs. 0.07). Ultrasound use (0.72 vs. 0.55) and the number of blood tests (median 33 vs. 21 tests per patient) were higher in the SeHCAT-negative group whereas the SeHCAT-positive group attended more clinic appointments (p=0.013).
Conclusion A positive diagnosis of bile acid diarrhoea, made by a SeHCAT test, resulted in reduced use of diagnostic investigations over the subsequent five years.
Disclosure of Interest J. Turner: None Declared, S Pattni: None Declared, R Appleby: None Declared, J Walters Conflict with: Intercept, Novartis, Conflict with: GE Healthcare
- bile acid malabsorption