Introduction Bile acid malabsorption (BAM) is increasingly recognised as the underlying diagnosis in many patients with D-IBS and Crohn’s disease, and SeHCAT testing has greatly increased. The 2012 NICE consultation document 1 acknowledges lack of evidence of cost effectiveness and advocates trial of treatment with bile acid sequestrants (BAS) rather than SeHCAT for Crohn’s patients, but often these are poorly tolerated and the response equivocal. We review our experience of SeHCAT testing and review it with respect to NICE.
Methods Retrospective review of 121 consecutive patients who had SeHCAT performed between April 2009 and December 2012. Patient demographics, associated diseases (Crohn’s disease, right hemicolectomy, radiotherapy, HIV, microscopic colitis, coeliac disease, vagotomy and pyloroplasty, Graves disease, intestinal bypass, cholecystectomy), symptoms, previous tests and outcomes of BAS were reviewed. Logistic regression was performed to determine predictors of BAM.
Results Patient age range was 18–85 years, median 50 years with the majority female (76; 63%). Of the patients investigated with SeHCAT scan, 78% had had a colonoscopy, 33% an OGD and 21% a CT scan.
Only Crohn’s disease and right hemicolectomy were significantly associated with BAM. The frequency and nature (steatorrhoea or watery diarrhoea) of the stool was not significantly correlated with BAM.
The number of SeHCAT tests increased from 2 in 2009 to 62 in 2012. 57 (47%) had a positive scan of who 83% were given BAS post-test and of these 52% had a good response to therapy, 23% didn’t respond and 10% couldn’t tolerate the BAS. 14% of patients had a trial of therapy pre-test;38% of these responded to therapy. 29% of patients given BAS weren’t seen after treatment so response is unknown. Unsurprisingly of those with a negative SeHCAT scan (n = 63) only one patient had a partial response to treatment. Of these 6 were given treatment prior to their test. Only one had Crohn’s disease and none had a right hemicolectomy so the trial of treatment in most was unnecessary.
Conclusion SeHCAT was often performed after many other investigations for diarrhoea. NICE guidelines suggest SeHCAT scan should be considered early in the investigation of chronic diarrhoea.
Of the SeHCAT scans performed, 57% were positive and could have prevented invasive tests if performed earlier. For patients with Crohn’s disease or right hemicolectomy sensitivity and PPV was sufficiently high to warrant treatment without testing as per NICE.
SeHCAT (Tauroselcholic [75Selenium] acid) for the investigation of bile acid malabsorption (BAM) and measurement of bile acid pool loss. http://guidance.nice.org.uk/DT/8
Disclosure of Interest None Declared.
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