Introduction Bile acid malabsorption (BAM) is a common cause of chronic diarrhoea that can be diagnosed by the SeHCAT test and treated with bile acid sequestrants (BAS). Colestyramine, the most commonly used BAS, is often poorly tolerated due to side effects including nausea, vomiting, flatulence and abdominal pain. Colesevelam, has recently been advocated, as a second line BAS therapy in patients who poorly tolerate colestyramine.¹ The purpose of this retrospective study was to determine the current use and efficacy of colesevelam in bile acid malabsorption.

Methods Case records were reviewed over a 6-year period for patients found to have a positive SeHCAT test (defined as retention ≤8%). The age and sex, indication for SeHCAT test, use of BAS and clinical response were noted.

Results SeHCAT tests were performed in 264 patients, of which a positive SeHCAT was found in 104 (39%). Data on use and response to BAS were found in 73. The majority (n=68) were given colestyramine as first line treatment with only five receiving colesevelam first line. Symptom improvement with colestyramine occurred in 41/68 (60%). 27/68 (40%) failed colestyramine therapy of which 2/3 were due to poor tolerance. 12 of these were then offered second line therapy with colesevelam. 42% of the 12 patients (n=5) who were given colesevelam after failing to respond to or tolerate colestyramine had a positive response to colesevelam second line. None of the patients reported poor tolerance to colesvelam. Overall BAS response was slightly higher among male patients (76% success in males vs 60% success in females) but there were no differences between different age groups.

Conclusion This retrospective study indicates a good response rate and good tolerance to colesevelam in colestyramine non-responders; however its use as second line therapy was low for reasons that are unclear. Further study is needed to establish whether colesevelam might have better efficacy than colestyramine as first line therapy and to raise awareness of its availability.

Competing interests None declared.

Reference 1. Wedlake L, A'Hern R, Russell D, et al. Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2009;30:707–17.