Idiopathic bile acid malabsorption: qualitative and quantitative clinical features and response to cholestyramine

Abstract

Background: Idiopathic bile acid malabsorption is a poorly recognized cause of chronic diarrhoea. The SeHCAT (75Selenium HomotauroCholic Acid Test) can accurately diagnose this condition. Aim: To identify patients with idiopathic bile acid malabsorption, to describe their clinical features, both qualitatively and quantitatively, and to assess the response to cholestyramine. Method: Idiopathic bile acid malabsorption was considered in all patients complaining of chronic diarrhoea. They were included in the study if their SeHCATs were positive (< 15% retention) and secondary causes of bile acid malabsorption were excluded. The response to therapy with cholestyramine was assessed. Results: Nine patients were diagnosed with idiopathic bile acid malabsorption (median SeHCAT retention 8%, range 3–12.6). Their median daily faecal weight was 285 g (range 85–676) and median faecal fat output was 17 mmol/24 h (range 8.3–38.8). Six patients had an immediate response to cholestyramine. There was a marked reduction in stool frequency (median stool frequency pre‐treatment 5/day vs. 2/day post‐treatment, P = 0.03). Five patients had large volume diarrhoea (faecal weight > 200 g/day) and three had steatorrhoea. Conclusions: Idiopathic bile acid malabsorption, once suspected, especially by documenting true ‘large volume’ watery diarrhoea or steatorrhoea, is easily diagnosed and response to therapy is often very good. There is often a previous history of gastrointestinal infection and this condition should be considered in patients with chronic diarrhoea of undetermined origin, especially before they are labelled as having irritable bowel syndrome.

Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy

“…12,34,35 A value of <5% was defi ned as severe, 5 to <10% as moderate and 10 to <15% as mild BAM. 22 The use of fully integrated electronic patient records since 2003 facilitated data collection.…”

Medical management of motility disorders in patients with intestinal failure: a focus on necrotizing enterocolitis, gastroschisis, and intestinal atresia

“…Bile salts entering the colon lead to secretory diarrhea [90]. Cholestyramine is a sequestering agent that partially interrupts the enterohepatic circulation with subsequent enhanced hepatic synthesis of bile acid from endogenous cholesterol [91].…”

[No Title Available]

“…Se o exame SeHCAT não estiver disponível, tentativa com colestiramina é uma alternativa razoável. A MAAB é caracterizada por sintomas noturnos e com peso das fezes acima de 250 g (33) . 6.…”

“…Como esta estimativa pode não ser precisa, se houver suspeita de um grande volume, deve ser realizada a coleta de fezes de 3 dias para avaliar o peso e outros testes (por exemplo, para detecção de laxantes, eletrólitos ou gordura nas fezes). Se o peso for alto (por exemplo, >350 g/dia), devem ser considerados exames de fezes adicionais e outros diagnósticos (33) . Exames mais especializados podem incluir aqueles de imagem que avaliem o intestino delgado e o abdome, teste respiratório de hidrogênio glicose ou SeHCAT/tentativa com colestiramina (32) .…”