Pros and Cons of the SeHCAT Test in Bile Acid Diarrhea: A More Appropriate Use of an Old Nuclear Medicine Technique

Fani, B.; Bertani, Lorenzo; Paglianiti, I; Fantechi, Lorenzo; Bortoli, Nicola de; Costa, Francesco; Volterrani, Duccio; Marchi, Santino; Bellini, Massimo

doi:10.1155/2018/2097359

Cited by 27 publications

(51 citation statements)

References 50 publications

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“…Since the primary cause of SBS is surgical resection of the small intestine, patient history of this procedure, and stoma output, may be indicative of SBS, with blood tests, stool or urine analyses, imaging and biopsies conducted to confirm the diagnosis[ 82 ]. Supporting the findings of this review, the SeHCAT scan is widely reported as a diagnostic test for BAM[ 83 ]. It is a validated method and does not require multiple stool samples, which may improve patient compliance[ 84 ].…”

Section: Discussionsupporting

confidence: 77%

Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review

Khan

Walter

Buchanan-Hughes

et al. 2020

WJG

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BACKGROUND Approximately 20% of patients with neuroendocrine tumours (NETs) develop carcinoid syndrome (CS), characterised by flushing and diarrhoea. Somatostatin analogues or telotristat can be used to control symptoms of CS through inhibition of serotonin secretion. Although CS is often the cause of diarrhoea among patients with gastroenteropancreatic NETs (GEP-NETs), other causes to consider include pancreatic enzyme insufficiency (PEI), bile acid malabsorption and small intestinal bacterial overgrowth. If other causes of diarrhoea unrelated to serotonin secretion are mistaken for CS diarrhoea, these treatments may be ineffective against the diarrhoea, risking detrimental effects to patient quality of life. AIM To identify and synthesise qualitative and quantitative evidence relating to the differential diagnosis of diarrhoea in patients with GEP-NETs. METHODS Electronic databases (MEDLINE, Embase and the Cochrane Library) were searched from inception to September 12, 2018 using terms for NETs and diarrhoea. Congresses, systematic literature review bibliographies and included articles were also hand-searched. Any study designs and publication types were eligible for inclusion if relevant data on a cause(s) of diarrhoea in patients with GEP-NETs were reported. Studies were screened by two independent reviewers at abstract and full-text stages. Framework synthesis was adapted to synthesise quantitative and qualitative data. The definition of qualitative data was expanded to include all textual data in any section of relevant publications. RESULTS Forty-seven publications (44 studies) were included, comprising a variety of publication types, including observational studies, reviews, guidelines, case reports, interventional studies, and opinion pieces. Most reported on PEI on/after treatment with somatostatin analogs; 9.5%-84% of patients with GEP-NETs had experienced steatorrhoea or confirmed PEI. Where reported, 14.3%–50.7% of patients received pancreatic enzyme replacement therapy. Other causes of diarrhoea reported in patients with GEP-NETs included bile acid malabsorption (80%), small intestinal bacterial overgrowth (23.6%-62%), colitis (20%) and infection (7.1%). Diagnostic approaches included faecal elastase, breath tests, tauroselcholic (selenium-75) acid (SeHCAT) scan and stool culture, although evidence on the effectiveness or diagnostic accuracy of these approaches was limited. Assessment of patient history or diarrhoea characteristics was also reported as initial approaches for investigation. From the identified evidence, if diarrhoea is assumed to be CS diarrhoea, consequences include uncontrolled diarrhoea, malnutrition, and perceived ineffectiveness of CS treatment. Approaches for facilitating differential diagnosis of diarrhoea include improving patient and clinician awareness of non-CS causes and involvement of a multidisciplinary clinical team, including gastroenterologists. CON...

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Section: Discussionsupporting

confidence: 77%

Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review

Khan

Walter

Buchanan-Hughes

et al. 2020

WJG

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“…Diagnosis of bile acid and fat malabsorption is important, as the diarrhoea they cause can often be relieved by appropriate treatment and dietary restrictions. In recent years, the 75-selenium homocholic acid taurine (SeHCAT) test has become increasing used worldwide for the diagnosis of bile acid malabsorption, being simple, fast and well-tolerated, and having higher sensitivity and specificity than other methods [52].…”

Section: Commentsmentioning

confidence: 99%

Diagnosis and treatment of gastrointestinal dysfunction in hereditary TTR amyloidosis

Obici

Suhr

2019

Clin Auton Res

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Purpose To review the management of gastrointestinal symptoms in patients with hereditary transthyretin amyloidosis, discussing diagnostic evaluations, assessment of disease progression and therapeutic strategies that could be implemented in routine practice. Methods Literature review. Key search terms included "gastrointestinal symptoms", "autonomic neuropathy", "hereditary transthyretin amyloidosis" and "familial amyloid polyneuropathy". Results Gastrointestinal disturbances are a common and serious manifestation of hereditary transthyretin amyloidosis, with significant effects on patients' quality of life and demonstrating a strong association with mortality. Gastrointestinal involvement is more often subclinical in the early stages of the disease, although in some patients gastric and/or bowel abnormalities may be the inaugural symptoms. In both cases, under-recognition, delayed investigation and suboptimal treatment frequently occur. A clear understanding of the mechanisms underlying gastrointestinal dysfunction in hereditary transthyretin amyloidosis is still lacking, but similar to diabetic enteropathy, multiple pathophysiological alterations seem to play a role. Conclusions Early detection and treatment of gastrointestinal disturbances is key to the successful treatment of this devastating disease. Gastroenterologists play a valuable role in both the diagnosis and the timely management of gastrointestinal symptoms in hereditary transthyretin amyloidosis and should, therefore, be part of a multidisciplinary and comprehensive approach to this disorder.

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“…4 A nuclear medicine investigation, the selenium-75-homocholic acid taurine (SeHCAT) test, is the preferred method for diagnosing BAD. [7][8][9] Although SeHCAT gives a quantitative assessment of BAD severity and may be helpful to predict the response to therapy, its use in everyday clinical practice is hampered by its cost, the lack of general agreement on the cut-off value and its limited availability. 7 However, 63% of patients with bile acid malabsorption successfully respond to the treatment with bile acid sequestrants, showing a trend to decreased response with reduced severity of bile acid malabsorption.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and clinical features of bile acid diarrhea in patients with chronic diarrhea

Costa

Gattoni

Nicolardi

et al. 2021

J of Digest Diseases

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ObjectiveBile acid diarrhea is a form of chronic diarrhea caused by excessive bile reaching the colon. Conditions involving the terminal ileum and cholecystectomy are predisposing factors but an idiopathic form of bile acid diarrhea has also been described. In this study we aimed to evaluate the prevalence of bile acid diarrhea in patients consecutively evaluated for chronic diarrhea in an Outpatient Gastroenterology Clinic.MethodsMedical records of all patients admitted for chronic diarrhea (>4 weeks) between June 2018 and April 2019 were retrospectively reviewed. Bile acid diarrhea was suspected in patients with ileal disease, cholecystectomy or post‐prandial diarrhea. Patients’ age at diagnosis, sex, presenting symptoms, results of main test and examinations, final diagnoses and date of last follow‐up visit were also collected. Exclusion of chronic diarrhea of other causes and a 6‐month clinical improvement with cholestyramine treatment confirmed the diagnosis of bile acid diarrhea.ResultsIn total, 139 patients aged 46 ± 20 years (76 women and 63 men) were included. Diarrhea due to an organic cause was diagnosed in 16 patients. A clinical response to cholestyramine persisting for more than 6 months led to a diagnosis of bile acid diarrhea in 39 (aged 52 ± 19 years) out of the remaining 123 patients with functional forms of diarrhea. Therefore, the prevalence of bile acid diarrhea was 28.1% (95% confidence interval 19.9%‐38.4%) in patients with chronic diarrhea.ConclusionsBile acid diarrhea is a very common, yet under‐recognized cause of chronic functional diarrhea. A therapeutic trial of cholestyramine is a valid diagnostic strategy.

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Pros and Cons of the SeHCAT Test in Bile Acid Diarrhea: A More Appropriate Use of an Old Nuclear Medicine Technique

Cited by 27 publications

References 50 publications

Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review

Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review

Diagnosis and treatment of gastrointestinal dysfunction in hereditary TTR amyloidosis

Prevalence and clinical features of bile acid diarrhea in patients with chronic diarrhea

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