Systematic review: the management of chronic diarrhoea due to bile acid malabsorption

Wilcox, C. Mel; Turner, Jeff; Green, John

doi:10.1111/apt.12684

Cited by 116 publications

(133 citation statements)

References 53 publications

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“…[18][19][20][21][22][23][24] Colestyramine, the most commonly used BAS believed to reduce symptoms, is poorly tolerated due to its unpleasant texture and side effects, including nausea, bloating, fl atulence and abdominal pain. 8,10,12,25 Consequently, over half of people started on colestyramine discontinue the medication within a year, often sooner. 26 Failing to respond to it may imply lack of concordance not lack of effi cacy, rendering 'trial by treatment' a poor diagnostic test.…”

Section: Introductionmentioning

confidence: 99%

“…The BAS colesevelam is currently unlicensed for use in BAM, but advocated as an alternative. 25,27,28 Compared with colestyramine, colesevelam has a 4-6 times stronger binding affi nity to bile acids. 28,29 It also has a lower side-effect profi le and fewer clinical Results 270 patients underwent SeHCAT testing; the electronic patient records at the trust meant only six patients were excluded due to a lack of key data.…”

Section: Introductionmentioning

confidence: 99%

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Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy

et al. 2015

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Although recognised as a cause of chronic diarrhoea for over forty years, diagnostic tests and treatments for bile acid malabsorption (BAM) remain controversial. Recent National Institute for Health and Care Excellence (NICE) guidelines highlighted the lack of evidence in the fi eld, and called for further research. This retrospective study explores the BAM subtype and severity, the use and response to bile acid sequestrants (BAS) and the prevalence of abnormal colonic histology. 264 selenium-75-labelled homocholic acid conjugated taurine (SeHCAT)-tested patient records were reviewed and the severity and subtype of BAM, presence of colonic histopathology and response to BAS were recorded. 53% of patients tested had BAM, with type-2 BAM in 45% of patients with presumed irritable bowel syndrome. Colonic histological abnormalities were similar overall between patients with (29%) or without (23%) BAM (p=0.46) and between BAM subtypes, with no signifi cant presence of infl ammatory changes. 63% of patients with BAM had a successful BAS response which showed a trend to decreased response with reduced severity. Colestyramine was unsuccessful in 44% (38/87) and 45% of these (17/38) were related to medication intolerance, despite a positive SeHCAT. 47% (7/15) of colestyramine failures had a successful colesevelam response. No patient reported colesevelam intolerance. Quantifying severity of BAM appears to be useful in predicting BAS response. Colesevelam was better tolerated than colestyramine and showed some effi cacy in colestyramine failures. Colestyramine failure should not be used to exclude BAM. Colonic histology is of no relevance.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy

et al. 2015

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“…En un estudio con 15 pacientes como primera línea, el colesevelam logró una mejoría de los síntomas en un 87% (51). Como segunda línea posterior a la administración de colestiramina la mejoría fue del 57% (47). No hay ensayos clínicos controlados grandes del uso del colesevelam y además su costo es más elevado, condiciones que limitan su uso (47,52).…”

Section: -Colesevelamunclassified

“…Como segunda línea posterior a la administración de colestiramina la mejoría fue del 57% (47). No hay ensayos clínicos controlados grandes del uso del colesevelam y además su costo es más elevado, condiciones que limitan su uso (47,52).…”

Section: -Colesevelamunclassified

Diarrea pos colecistectomía, enfoque diagnóstico y terapéutico

Jaramillo¹,

S²,

Regino³

2017

Rev. Med.

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RESUMENLa colelitiasis es una enfermedad muy prevalente en la población general. El tratamiento de la colelitiasis, cuando se torna sintomática, es fundamentalmente quirúrgico. Una de sus complicaciones es la diarrea pos-colecistectomía que se define como la presencia de 3 o más deposiciones diarreicas por día por más de cuatro semanas en pacientes con el antecedente de colecistectomía, en ausencia de otra causa que explique la sintomatología. Debido a la incidencia reportada en la literatura alrededor del 15%, esta revisión presenta la epidemiologia, fisiopatología, diagnóstico, clasificación y tratamiento de esta patología. Adicionalmente se plantea una nueva clasificación de la patología que se correlacione con la fisiopatología.

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“…The lack of proper diagnostic approaches and limited number of clinical guidelines on the appropriate management of patients with BAM making the disease under-recognized and a great challenge for gastroenterologists [45]. Further complicating the situation that cholestyramine (a bile acid sequestrant) therapy does not solve the problem in every case [3,9,33,47]. Moreover, cholestyramine treatment can reduce the bioavailability of coadministered drugs as well.…”

Section: Introductionmentioning

confidence: 99%

Crucial role of pancreatic ducts in the initiation and progression of pancreatitis

Maléth¹

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Systematic review: the management of chronic diarrhoea due to bile acid malabsorption

Abstract: SUMMARY BackgroundBile acid malabsorption (BAM) is a common, yet under-recognised, cause of chronic diarrhoea, with limited guidance available on the appropriate management of patients with BAM.

Cited by 116 publications

References 53 publications

Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy

Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy

Diarrea pos colecistectomía, enfoque diagnóstico y terapéutico

Crucial role of pancreatic ducts in the initiation and progression of pancreatitis

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