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Original article
Biomarkers for bile acid diarrhoea in functional bowel disorder with diarrhoea: a systematic review and meta-analysis
  1. Nelson Valentin1,
  2. Michael Camilleri1,
  3. Osama Altayar2,
  4. Priya Vijayvargiya1,
  5. Andres Acosta1,
  6. Alfred D Nelson1,
  7. M Hassan Murad3
  1. 1Division of Gastroenterology, Department of Internal Medicine, Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
  3. 3Division of Preventive Medicine, Department of Internal Medicine, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Professor Michael Camilleri, Mayo Clinic, 200 First St SW, Charlton Bldg, Rm 8-110, Rochester, MN 55905, USA; camilleri.michael{at}


There is no universally available laboratory test to diagnose bile acid diarrhoea (BAD).

Objective To conduct a systematic review and meta-analysis to identify a biomarker for idiopathic BAD in patients with functional bowel disorder (FBD) with diarrhoea.

Design We searched multiple databases through 15 May 2015. Data were only available to estimate the diagnostic yield of each test (the prevalence of a positive test). Estimates were pooled across studies using the random effects model.

Results We included 36 studies, enrolling 5028 patients (24 using 75selenium homotaurocholic acid test (75SeHCAT) retention of <10%, 6 using fasting serum C4, 3 using fasting serum fibroblast growth factor 19 (FGF19) and 2 based on total faecal bile acid (BA) excretion over 48 h). The diagnostic yields (and 95% CI) of abnormal tests were: 0.308 (0.247 to 0.377) for 75SeHCAT retention (<10%), 0.171 (0.134 to 0.217) for serum C4, 0.248 (0.147 to 0.385) for serum FGF19 and 0.255 (0.071 to 0.606) for total faecal BA excretion over 48 h. The majority of the analyses were associated with substantial heterogeneity. Performance characteristics relative to a gold standard test could not be estimated.

Conclusions Overall, the test with the highest diagnostic yield conducted in the largest number of studies was 75SeHCAT retention, which is not widely available in many countries outside Europe and Canada. Using different diagnostic tests, 25% (average) of patients with lower FBD with diarrhoea has evidence of idiopathic BAD. These tests serve to identify idiopathic BAD among patients with FBD with diarrhoea. Further studies are required to appraise the performance characteristics of tests for idiopathic BAD.


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  • Contributors NV: review of articles for eligibility and data extraction, authorship. MC: principal investigator, content expertise, authorship. OA: review of articles for eligibility, evaluation of quality. PV: data extraction, evaluation of quality. AA: coinvestigator, content expertise. ADN: data extraction. MHM: supervision of review methodology and statistical analysis. Guarantor of the article: MC accepts full responsibility for the conduct of the study.

  • Funding MC is supported by grants R01-DK92179 and R01-DK67071 from National Institutes of Health. The work was also supported by CTSA grant UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.