The Epidemiology of Bile Acid Diarrhea in Denmark

Abstract

Objective Bile acid diarrhea (BAD) is a socially debilitating disease with frequent bowel movements, urgency, and fecal incontinence as the main symptoms. It is caused by excessive bile acid levels in the colon and is most commonly treated with bile acid sequestrants. It is estimated that 1–2% of the population suffers from the disease, but only a fraction of these are properly diagnosed with the gold standard ⁷⁵selenium-homotaurocholic acid (SeHCAT) test. Here, we use nationwide registries to describe the demographic characteristics of individuals suffering from BAD in Denmark. Methods Since the International Classification of Diseases diagnosis code for BAD was not used until 2021, we identified the BAD population by referral to SeHCAT testing followed by a prescription of a bile acid sequestrant (colestyramine, colestipol or colesevelam) within 365 days. The study period was from 2003 to 2021. Results During the study period, a total of 5264 individuals with BAD were identified with large differences between the five regions in Denmark. The number of prescriptions of colestyramine and colesevelam, the number of SeHCAT tests, and the number of individuals diagnosed with BAD increased during the study period. The BAD population had more co-morbidities and more health care contacts as well as lower levels of education and income compared with age- and sex-matched controls from the general population. Conclusion Using the Danish registries, we identified a BAD population, which seems to be inferior in health care and socio-economic parameters compared with the Danish general population.

Risk of cancer in patients with bile acid diarrhoea: a Danish nationwide matched cohort study

“…1 Our included number of cases reflects a prevalence about 0.1% in Denmark using the same case definition. 34 Some patients with undiagnosed BAD could have been included as controls of this study, but we deem the impact of such misclassification bias negligible. Increasing awareness of BAD means a higher number of diagnosed cases in recent years, so more data should be available for epidemiological studies of BAD in the near future.…”

“…Increasing awareness of BAD means a higher number of diagnosed cases in recent years, so more data should be available for epidemiological studies of BAD in the near future. 34 We encourage researchers with access to similar data from other countries to investigate longterm outcomes of BAD.…”

The Epidemiology of Bile Acid Diarrhea in Denmark [Letter]

“…The study provides a comprehensive analysis of the demographic characteristics of individuals suffering from bile acid diarrhea (BAD) in Denmark, based on national registries. 1 …”

“…The study provides a comprehensive analysis of the demographic characteristics of individuals suffering from bile acid diarrhea (BAD) in Denmark, based on national registries. 1 The authors used a robust methodology, utilizing the Danish national registry to identify individuals with BAD, defined by a diagnosis of ICD10 code K90.8B or a SeHCAT test followed by a prescription of bile acid sequestrants within 365 days. The study revealed important findings, including regional differences in the frequency of BAD diagnoses in Denmark, lower income and education levels among individuals suffering from BAD compared to matched controls, and an increase in the number of BAD diagnoses over time.…”

The Epidemiology of Bile Acid Diarrhea in Denmark [Letter]

“…The results of this research have advantages, namely: 1) Identify individuals with bile acid diarrhea (BAD) in Denmark using data from the national registry, 2) Identify individuals suffering from BAD based on ICD10 diagnosis codes or SeHCAT test followed by prescription of bile acid binders within a period of 365 days, 3) Show differences in the frequency of BAD diagnosis in different regions of Denmark, 4) Provide information on the characteristics of individuals suffering from BAD, including lower education level, lower income, and higher number of contacts with health services compared to a comparable control group, 5) Track the use of liraglutide as a potential therapy for BAD. 1 …”