The efficacy of a low-fat diet to manage the symptoms of bile acid malabsorption – outcomes in patients previously treated for cancer

Abstract

Dietary fat ingestion triggers bile secretion into the gastrointestinal tract. Bile acid malabsorption affects >1% of the population, causing loose stool and other gastrointestinal symptoms. The diagnosis is frequently missed. Treatments are often considered ineffective. We evaluated low-fat diets for managing gastrointestinal symptoms in these patients. All patients reporting type 6 or 7 stool were offered a selenium-75 homocholic acid taurine (SeHCAT) scan. Prospective data in patients with 7-day scan retention <20% were analysed. Patients requiring a bile acid sequestrant were given this before receiving dietary advice. Patients completed a 7-day food diary before dietetic consultations. Personalised dietary interventions, providing 20% of daily energy from fat, were prescribed. Symptoms were assessed using a modifi ed gastrointestinal symptom rating scale questionnaire before and 4-12 weeks after dietary intervention. A total of 114 patients (49 male, median age 64 years, median body mass index 27 kg/m 2 ) were evaluated. 44% of these patients were taking colesevelam. After dietary intervention, there was statistically signifi cant improvement in abdominal pain and nocturnal defecation (0.2% alpha, p=0.001). Improvement in bowel frequency, urgency, fl atulence, belching, borborygmi and stool consistency were seen, but did not reach statistical signifi cance (p≤0.004-0.031). Dietary intervention is an effective treatment option for patients with symptomatic bile acid malabsorption and should be routinely considered. ABSTRACTThe efficacy of a low-fat diet to manage the symptoms of bile acid malabsorption -outcomes in patients previously treated for cancer

Bile Acid Malabsorption as a Consequence of Cancer Treatment: Prevalence and Management in the National Leading Centre

“…Symptoms of patients with moderate or severe BAM are stabilised with colesevelam (cholestyramine) first and then the patients are reviewed by the dietitian [ 41 ]. Prospective evaluations of low-fat dietary interventions in managing BAM have demonstrated significant improvements in symptoms, where total fat has been reduced to 20% of daily energy intake [ 42 , 43 ]. Caution is used with patients who have a low body weight or poor oral intake and they are generally commenced on colesevelam in the first instance to optimise their symptoms.…”

Long‐term effect of medical treatment of diarrhoea in 377 patients with SeHCATscan diagnosed bile acid malabsorption from 2003 to 2016; a retrospective study

“…A case series with 40 patients has demonstrated that thorough dietary instructions with reduced fat diets have positive impact on these symptoms . A newly published larger study confirm that dietitian instructed low fat diet has an effect of symptoms other than diarrhoea in bile acid diarrhoea …”

Long‐term gastrointestinal sequelae in colon cancer survivors: prospective pilot study on identification, the need for clinical evaluation and effects of treatment

“…However, no systematic studies of the actual use or effect of bile acid sequestrants in colon cancer survivors have been performed [31]. In addition, no studies have compared the effect of bile acid sequestrants with the effect of a fat-reduced diet [11,32]. Furthermore, one must bear in mind that there are several other gastrointestinal causes of chronic diarrhoea; thus, a systematic clinical evaluation is warranted [8,13].…”