Bile acid malabsorption in patients with chronic diarrhoea: clinical value of SeHCAT test.
BACKGROUND
Bile acid malabsorption (BAM), a cause of chronic diarrhoea, can be diagnosed by the SeHCAT test. The purpose of this study was to evaluate the usefulness of SeHCAT testing by assessing the extent of BAM and describing the clinical characteristics in a group of patients with chronic diarrhoea. Clinical outcome after treatment with cholestyramine was also evaluated.


METHODS
During a 5-year period (1997-2001) the SeHCAT test was performed in 135 patients in whom a primary programme for diagnostic evaluation of chronic diarrhoea had not revealed a cause. File data from 133 patients could be evaluated.


RESULTS
In 44% of patients, bile acid absorption was normal with SeHCAT retention > or = 15%. Impaired SeHCAT retention was found in 56%. All patients with ileocaecal resections had retention values < 10%. Patients with microscopic colitis presented with BAM in 39%. Only one patient with idiopathic BAM presented with steatorrhoea as opposed to 11 patients with type 1 and 3 BAM. Patients with idiopathic BAM and/or SeHCAT retention values < 5% had the best response to treatment with cholestyramine.


CONCLUSIONS
The SeHCAT test is of value in evaluation of patients with chronic diarrhoea as a second-line investigation with a high diagnostic yield. The only a priori parameter to predict BAM was the existence of ileocaecal resections. The result of the SeHCAT test seems to predict the benefit of treatment with cholestyramine.
Wildt
S
S
Dept. of Medical Gastroenterology, Hvidovre Hospital, University Hospital of Copenhagen, Denmark. siw@dadlnet.dk
Nørby Rasmussen
S
S
Lysgård Madsen
J
J
Rumessen
J J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000837:Anion Exchange Resins / Q000627:therapeutic use; D001647:Bile Acids and Salts / Q000493:pharmacokinetics; D002792:Cholestyramine Resin / Q000627:therapeutic use; D002908:Chronic Disease; D003967:Diarrhea / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D008286:Malabsorption Syndromes / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012644:Selenium Radioisotopes; D012720:Severity of Illness Index; D013656:Taurocholic Acid / Q000031:analogs & derivatives*; D016896:Treatment Outcome
D000837:Anion Exchange Resins; D001647:Bile Acids and Salts; D012644:Selenium Radioisotopes; D002792:Cholestyramine Resin; D013656:Taurocholic Acid; C033638:23-seleno-25-homotaurocholic acid