Prevalence of, and predictors of, bile acid malabsorption in outpatients with chronic diarrhea.

Published on Nov 1, 2012in Neurogastroenterology and Motility2.946
· DOI :10.1111/J.1365-2982.2012.01953.X
David J. Gracie16
Estimated H-index: 16
(St James's University Hospital),
John S Kane7
Estimated H-index: 7
(St James's University Hospital)
+ 3 AuthorsAlexander C. Ford86
Estimated H-index: 86
(University of Leeds)
Sources
Abstract
AbstractBackground Many physicians do not consider thediagnosis of bile acid malabsorption in patients withchronic diarrhea, or do not have access to testing. Weexamined yield of 23-seleno-25-homo-tauro-cholicacid (SeHCAT) scanning in chronic diarrhea patients,and attempted to identify predictors of a positive test.Methods Consecutive patients with chronic diarrheaundergoing SeHCAT scan over a 7-year period wereidentified retrospectively. Bile acid malabsorption wasdefined as present at a retention of <15%. Medicalrecords were reviewed to obtain information regardingproposed risk factors. Gastrointestinal symptoms wererecorded, and patients were classified as having diar-rhea-predominant irritable bowel syndrome (IBS-D) ifthey reported abdominal pain or discomfort. Inde-pendent risk factors were assessed using multivariatelogistic regression, and odds ratios (ORs) with 99%confidence intervals (CIs) were calculated. KeyResults Of 373 patients, 190 (50.9%) had bile acidmalabsorption. Previous cholecystectomy (OR 2.51;99% CI 1.10–5.77), terminal ileal resection or righthemicolectomy for Crohn’s disease (OR 12.4; 99% CI2.42–63.8), and terminal ileal resection or right hemi-colectomy for other reasons (OR 7.94; 99% CI 1.02–61.6) were associated with its presence. Seventy-sevenpatients had IBS-D, and 21 (27.3%) tested positive.There were 168 patients with no risk factors for apositive SeHCAT scan, other than chronic diarrhea,and 63 (37.5%) had bile acid malabsorption.Conclusions & Inferences Bile acid malabsorptionwas present in 50% of patients undergoing SeHCATscanning. Almost 40% of those without risk factorshad evidence of bile acid malabsorption, and in thosemeeting criteria for IBS-D prevalence was almost 30%.Keywords bile acid malabsorption, diarrhea, irritablebowel syndrome, SeHCAT scan.Abbreviations: CI, confidence interval; IBS-D, diarrhea-predominant irritable bowel syndrome; OR, odds ratio;SeHCAT, 23-seleno-25-homo-tauro-cholic acid; SD,standard deviation.Chronic diarrhea occurring as a result of bile saltsentering the colon, so-called bile acid malabsorption,was first described in 1967.
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