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
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.