Colonoscopy and SeHCAT for investigation of chronic diarrhea.
OBJECTIVE
Chronic diarrhea is a common problem. Colonoscopy is the investigation of choice for diagnosis. Even a macroscopically normal mucosa on endoscopy can have abnormalities such as microscopic colitis and bile acid malabsorption (BAM). The aim of this study was to establish the value of colonoscopy with biopsies in patients with chronic diarrhea and to evaluate the additive value of a SeHCAT test for diagnosing BAM in these patients.


METHODS
All patients who underwent a colonoscopy between November 1999 and December 2000 were included. Patient files, colonoscopy and pathology reports and SeHCAT test results were reviewed.


RESULTS
205 patients were included. The most common diagnoses were diarrhea-predominant IBS (n = 76) and IBD (n = 38). 158 patients had non-bloody diarrhea, 113 (72%) of them had a macroscopically normal appearing mucosa. In 40 (35%) of these patients, a histological diagnosis could be made and microscopic colitis was the most common diagnosis (n = 27). SeHCAT test was performed in 36 patients and 15 (42%) of them had BAM. In the 47 patients with bloody diarrhea, IBD was the main diagnosis (n = 23).


CONCLUSIONS
Colonoscopy with biopsies must be performed when investigating chronic diarrhea and BAM should be excluded.
Müller
Marcella
M
Section of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Goteborg SE-413 45, Sweden.
Willén
Roger
R
Stotzer
Per-Ove
PO
D001647:Bile Acids and Salts / Q000493:pharmacokinetics*; D001706:Biopsy; D002908:Chronic Disease; D003113:Colonoscopy; D003967:Diarrhea / Q000209:etiology*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000175:diagnosis*; D007413:Intestinal Mucosa / Q000473:pathology; D008286:Malabsorption Syndromes / Q000175:diagnosis*; D012189:Retrospective Studies; D012644:Selenium Radioisotopes; D013656:Taurocholic Acid
D001647:Bile Acids and Salts; D012644:Selenium Radioisotopes; D013656:Taurocholic Acid