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

Abstract

Background Many physicians do not consider the diagnosis of bile acid malabsorption in patients with chronic diarrhea, or do not have access to testing. We examined yield of 23‐seleno‐25‐homo‐tauro‐cholic acid (SeHCAT) scanning in chronic diarrhea patients, and attempted to identify predictors of a positive test. Methods Consecutive patients with chronic diarrhea undergoing SeHCAT scan over a 7‐year period were identified retrospectively. Bile acid malabsorption was defined as present at a retention of <15%. Medical records were reviewed to obtain information regarding proposed risk factors. Gastrointestinal symptoms were recorded, and patients were classified as having diarrhea‐predominant irritable bowel syndrome (IBS‐D) if they reported abdominal pain or discomfort. Independent risk factors were assessed using multivariate logistic regression, and odds ratios (ORs) with 99% confidence intervals (CIs) were calculated. Key Results Of 373 patients, 190 (50.9%) had bile acid malabsorption. Previous cholecystectomy (OR 2.51; 99% CI 1.10–5.77), terminal ileal resection or right hemicolectomy for Crohn’s disease (OR 12.4; 99% CI 2.42–63.8), and terminal ileal resection or right hemicolectomy for other reasons (OR 7.94; 99% CI 1.02–61.6) were associated with its presence. Seventy‐seven patients had IBS‐D, and 21 (27.3%) tested positive. There were 168 patients with no risk factors for a positive SeHCAT scan, other than chronic diarrhea, and 63 (37.5%) had bile acid malabsorption. Conclusions & Inferences Bile acid malabsorption was present in 50% of patients undergoing SeHCAT scanning. Almost 40% of those without risk factors had evidence of bile acid malabsorption, and in those meeting criteria for IBS‐D prevalence was almost 30%.

Negative Effects on Psychological Health and Quality of Life of Genuine Irritable Bowel Syndrome–type Symptoms in Patients With Inflammatory Bowel Disease

“…Furthermore, one-in-three CD patients had undergone intestinal resection previously and, given that bile acid diarrhea or small intestinal bacterial overgrowth may occur as a result of surgery, 10,11 and that there is overlap between the symptoms of these conditions and those of IBS, 12,13 it is possible that we have overestimated the prevalence of IBS. In addition, gold-standard investigations for IBD activity, including small bowel imaging and ileocolonoscopy were not performed routinely as the study was conducted within usual clinical practice.…”

Irritable Bowel Syndrome and Microscopic Colitis: A Systematic Review and Meta-analysis

“…In recent years, interest in the potential for a missed organic GI diagnosis in patients with suspected IBS has increased. Previous studies have suggested that symptoms compatible with IBS may co-exist in patients with several organic GI diseases, such as inflammatory bowel disease, coeliac disease, or bile acid diarrhea, [15][16][17] and that some patients who meet criteria for IBS may have one of these underlying organic diseases. [18][19][20][21] Microscopic colitis (MC) consists of two primary subtypes: collagenous and lymphocytic colitis.…”

Validation of the Rome III Criteria for the Diagnosis of Irritable Bowel Syndrome in Secondary Care

“…7 Individuals with IBS are more likely to consume health care resources than healthy individuals, 8 with up to 80% of sufferers consulting their primary care physician as a result of symptoms. 9,10 Diagnosing IBS can be challenging due to overlap between the symptoms that sufferers report and those of organic GI conditions such as celiac disease, [11][12][13] small intestinal bacterial overgrowth, 14 bile acid diarrhea, 15,16 exocrine pancreatic insufficiency, 17 or inflammatory bowel disease. 18 Partly as a result of this uncertainty, symptom-based diagnostic criteria were developed for use by physicians consulting with patients with suspected IBS as early as the 1970s, with Manning et al reporting six symptoms that were commoner among individuals found ultimately to have IBS after investigation.…”