Systematic review with meta‐analysis: the prevalence of bile acid malabsorption and response to colestyramine in patients with chronic watery diarrhoea and previous cholecystectomy

Ruiz-Campos, Laura; Gisbert, Javier P.; Ysamat, M.; Arau, Beatriz; Loras, Carme; Fernández‐Bañares, Fernando

doi:10.1111/apt.15099

Cited by 27 publications

(26 citation statements)

References 27 publications

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“…Despite significant heterogeneity, in a recent meta-analysis, aimed to determine the proportion of patients with BAM amongst 361 cases with watery diarrhea and previous cholecystectomy, the authors showed a pooled BA diarrhea rate of 70% (95% CI 56% -82%) regardless a 10% or 15% 75 SeHCAT cut-off. Five out of eight studies (166 patients) demonstrated that cholestyramine treatment achieved a pooled response rate of 79% (95% CI 63% to 91%), thus confirming the usefulness of this BA sequestrant in patients with post-cholecystectomy associated BAM [29].…”

Section: Discussionmentioning

confidence: 66%

Methods for Diagnosing Bile Acid Malabsorption: A Systematic Review

Lyutakov

Ursini

Penchev

et al. 2019

Preprint

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BackgroundBile acid malabsorption (BAM) and bile acid-related diarrhea represent an under-recognized cause of chronic diarrhea mainly because of limited guidance on appropriate diagnostic and laboratory tests.ObjectiveTo perform a systematic review of the literature in order to identify and compare the diagnostic accuracy of different diagnostic methods for patients with bile acid malabsorption.DesignA PubMed literature review and a manual search were carried out. Relevant full papers, evaluating the diagnostic accuracy of different methods for BAM, were assessed. Available data were analyzed to estimate the sensitivity and specificity of each published test.ResultsOverall, more than one tests was considered in published papers on BAM. The search strategy retrieved 574 articles; of these, only 16 were full papers (with a total of 2.332 patients) included in the final review. Specifically, n=8 studies used 75 Selenium-homotaurocholic-acid-test ( 75 SeHCAT) with a <10% retention threshold; n=8 studies evaluated fasting serum 7-α-hydroxy-4-cholesten-3-one (C4); n=3 studies involved total fecal bile acid (BA) excretion over 48h; n=4 studies assessed fibroblast growth factor 19 (FGF19). 75 SeHCAT showed an average sensitivity and specificity of 87.32% and 93.2%, respectively, followed by serum C4 (85.2% and 71.1%) and total fecal BA (66.6% and 79.3%). Fasting serum FGF19 had the lowest sensitivity and specificity (63.8% and 72.3%). All the extracted data were associated with substantial heterogeneity.ConclusionsOur systematic review indicates that 75 SeHCAT has the highest diagnostic accuracy for BAM, followed by serum C4 assay. The diagnostic yield of fecal BA and FGF19 assays is still under investigation. Our review reinforces the need for novel biomarkers aimed to an objective detection of BAM and therefore improving the management of this condition.

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Section: Discussionmentioning

confidence: 66%

Methods for Diagnosing Bile Acid Malabsorption: A Systematic Review

Lyutakov

Ursini

Penchev

et al. 2019

Preprint

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“…Despite significant heterogeneity, in a recent meta-analysis, aimed to determine the proportion of patients with BAM amongst 361 cases with watery diarrhea and previous cholecystectomy, the authors showed a pooled BA diarrhea rate of 70% (95% CI 56–82%) regardless a 10% or 15% 75 SeHCAT cut-off. Five out of eight studies (166 patients) demonstrated that cholestyramine treatment achieved a pooled response rate of 79% (95% CI 63 to 91%), thus confirming the usefulness of this BA sequestrant in patients with post-cholecystectomy associated BAM [36].…”

Section: Discussionmentioning

confidence: 89%

Methods for diagnosing bile acid malabsorption: a systematic review

et al. 2019

View full text Add to dashboard Cite

BackgroundBile acid malabsorption (BAM) and bile acid-related diarrhea represent an under-recognized cause of chronic diarrhea mainly because of limited guidance on appropriate diagnostic and laboratory tests. We aimed to perform a systematic review of the literature in order to identify and compare the diagnostic accuracy of different diagnostic methods for patients with BAM, despite a proven gold standard test is still lacking.MethodsA PubMed literature review and a manual search were carried out. Relevant full papers, evaluating the diagnostic accuracy of different methods for BAM, were assessed. Available data were analyzed to estimate the sensitivity and specificity of each published test.ResultsOverall, more than one test was considered in published papers on BAM. The search strategy retrieved 574 articles; of these, only 16 were full papers (with a total of 2.332 patients) included in the final review. Specifically, n = 8 studies used 75Selenium-homotaurocholic-acid-test (75SeHCAT) with a < 10% retention threshold; n = 8 studies evaluated fasting serum 7-α-hydroxy-4-cholesten-3-one (C4); n = 3 studies involved total fecal bile acid (BA) excretion over 48 h; n = 4 studies assessed fibroblast growth factor 19 (FGF19). 75SeHCAT showed an average sensitivity and specificity of 87.32 and 93.2%, respectively, followed by serum C4 (85.2 and 71.1%) and total fecal BA (66.6 and 79.3%). Fasting serum FGF19 had the lowest sensitivity and specificity (63.8 and 72.3%). All the extracted data were associated with substantial heterogeneity.ConclusionsOur systematic review indicates that 75SeHCAT has the highest diagnostic accuracy for BAM, followed by serum C4 assay. The diagnostic yield of fecal BA and FGF19 assays is still under investigation. Our review reinforces the need for novel biomarkers aimed to an objective detection of BAM and therefore improving the management of this condition.

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“…A recent systematic review and meta-analysis reported that two-thirds of patients with cholecystectomy had BAD on SeHCAT scanning. 26 The authors also demonstrated that such patients had a good response to colestyramine. No definitive association between celiac disease or microscopic colitis and BAD was demonstrated in our study; however, the number of individuals with these conditions was small.…”

Section: Discussionmentioning

confidence: 93%

“…We observed that around 60% of those with prior cholecystectomy had some degree of BAD. A recent systematic review and meta‐analysis reported that two‐thirds of patients with cholecystectomy had BAD on SeHCAT scanning . The authors also demonstrated that such patients had a good response to colestyramine.…”

Section: Discussionmentioning

confidence: 98%

Prevalence of, and predictors of, bile acid diarrhea in outpatients with chronic diarrhea: A follow‐up study

Lim

Gracie

Kane

et al. 2019

Neurogastroenterology Motil

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Background 23‐seleno‐25‐homo‐tauro‐cholic acid (SeHCAT) scanning to rule out bile acid diarrhea (BAD) in patients with chronic diarrhea has a high yield. Our previous study showed that patients with terminal ileal (TI) Crohn's disease, TI resection, or cholecystectomy were highly likely to have an abnormal scan. As a result, we encouraged clinicians to use a therapeutic trial of a bile acid sequestrant in these patients, instead of scanning. This may have reduced diagnostic yield of the test, so we examined this issue, as well as factors predicting an abnormal scan, in a large cohort of patients referred subsequently. Methods We retrospectively identified 1,071 consecutive patients with chronic diarrhea undergoing SeHCAT scanning at Leeds Teaching Hospitals Trust from 2012 to 2016. We reviewed electronic patient records to obtain information on presenting gastrointestinal symptoms and any proposed risk factors for BAD. BAD was categorized according to subtype and severity. Key Results As expected, indications for scanning changed between 2012 and 2016, with a significant reduction in referrals with TI Crohn's disease or resection year‐on‐year (P < 0.001). Despite this, 457 (42.7%) patients had BAD and there was no downward trend in yield of SeHCAT during the 5 year period (P = 0.39). Overall, 51.6% had type II BAD, 36.1% type III, and 12.3% type I. BAD was mild in 31.7%, moderate in 34.4%, and severe in 33.9%. In total, 653 (61.0%) patients had no known risk factors, other than chronic diarrhea, but 233 (35.7%) of these individuals had BAD, and in 143 (61.4%), this was moderate or severe. Conclusions and Inferences Despite reduced referrals for SeHCAT scanning in those with clear risk factors for BAD, the yield remained > 40%. One‐third of those without known risk factors had BAD.

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Systematic review with meta‐analysis: the prevalence of bile acid malabsorption and response to colestyramine in patients with chronic watery diarrhoea and previous cholecystectomy

Cited by 27 publications

References 27 publications

Methods for Diagnosing Bile Acid Malabsorption: A Systematic Review

Methods for Diagnosing Bile Acid Malabsorption: A Systematic Review

Methods for diagnosing bile acid malabsorption: a systematic review

Prevalence of, and predictors of, bile acid diarrhea in outpatients with chronic diarrhea: A follow‐up study

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