Role of bile acids and bile acid binding agents in patients with collagenous colitis.
BACKGROUND
In a retrospective study bile acid malabsorption was observed in patients with collagenous colitis.


OBJECTIVE
To study the occurrence of bile acid malabsorption and the effect of bile acid binders prospectively in patients with chronic diarrhoea and collagenous colitis.


METHODS
Over 36 months all patients referred because of chronic diarrhoea completed a diagnostic programme, including gastroscopy with duodenal biopsy, colonoscopy with biopsies, and the (75)Se-homocholic acid taurine ((75)SeHCAT) test for bile acid malabsorption. Treatment with a bile acid binder (cholestyramine in 24, colestipol in three) was given, irrespective of the results of the (75)SeHCAT test.


RESULTS
Collagenous colitis was found in 28 patients (six men, 22 women), 27 of whom had persistent symptoms and completed the programme. Four patients had had a previous cholecystectomy or a distal gastric resection. The (75)SeHCAT test was abnormal in 12/27 (44%) of the collagenous colitis patients with (75)SeHCAT values 0.5-9.7%, and normal in 15 patients (56%). Bile acid binding treatment was followed by a rapid, marked, or complete improvement in 21/27 (78%) of the collagenous colitis patients. Rapid improvement occurred in 11/12 (92%) of the patients with bile acid malabsorption compared with 10/15 (67%) of the patients with normal (75)SeHCAT tests.


CONCLUSIONS
Bile acid malabsorption is common in patients with collagenous colitis and is probably an important pathophysiological factor. Because of a high response rate without serious side effects, bile acid binding treatment should be considered for collagenous colitis, particularly patients with bile acid malabsorption.
Ung
K A
KA
Division of Gastroenterology, Department of Internal Medicine, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.
Gillberg
R
R
Kilander
A
A
Abrahamsson
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001647:Bile Acids and Salts / Q000378:metabolism*; D002792:Cholestyramine Resin / Q000627:therapeutic use; D002908:Chronic Disease; D003084:Colestipol / Q000627:therapeutic use; D003092:Colitis / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D003094:Collagen / Q000378:metabolism; D003967:Diarrhea / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D007408:Intestinal Absorption; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric
D000924:Anticholesteremic Agents; D001647:Bile Acids and Salts; D002792:Cholestyramine Resin; D003094:Collagen; D003084:Colestipol