title: Bile acid malabsorption: an under-investigated differential diagnosis in patients presenting with diarrhea predominant irritable bowel syndrome type symptoms.
abstract: OBJECTIVE
  Bile acid malabsorption (BAM) has been reported as a possible cause of diarrhea predominant irritable bowel syndrome (D-IBS) type symptoms. We aimed to determine how commonly patients with D-IBS type symptoms had a diagnosis of BAM as demonstrated by a positive SeHCAT (75 Selenium-homocholic acid taurine) test (retention <10% at seven days).
  
  
  METHODS
  A retrospective analysis was undertaken of patient's records for all patients who underwent a SeHCAT test between 2001 and 2009 in a tertiary hospital (Group A). Concurrently, a cohort of patients with Rome II D-IBS type symptoms was examined to determine the potential utility of SeHCAT test (Group B).
  
  
  RESULTS
  In Group A 39.2% (n = 107/273) of patients had a positive SeHCAT result. The median time from first hospital visit to SeHCAT result was 30 weeks. Predictive factors for BAM: terminal ileal Crohn's disease (p < 0.01), terminal ileal resection (p < 0.01), and previous cholecystectomy (p < 0.01). 33.6% of patients who had a positive SeHCAT also had Rome II D-IBS. In Group B the D-IBS control cohort only 1.9% of patients had undergone a SeHCAT scan (p < 0.001 compared to Group A).
  
  
  CONCLUSIONS
  BAM is common and should be considered earlier when investigating unselected patients with D-IBS type symptoms.
authors.affiliation: Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield, UK. mattkurien@hotmail.com
authors.forename: Matthew
authors.initials: M
authors.lastname: Kurien
authors.forename: Kate E
authors.initials: KE
authors.lastname: Evans
authors.forename: John S
authors.initials: JS
authors.lastname: Leeds
authors.forename: Andy D
authors.initials: AD
authors.lastname: Hopper
authors.forename: Andrew
authors.initials: A
authors.lastname: Harris
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001647:Bile Acids and Salts / Q000378:metabolism*; D016009:Chi-Square Distribution; D002763:Cholecystectomy; D002908:Chronic Disease; D003424:Crohn Disease / Q000150:complications; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology*; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000601:surgery; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000175:diagnosis; D016015:Logistic Models; D008286:Malabsorption Syndromes / Q000150:complications* / Q000175:diagnosis* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012644:Selenium Radioisotopes; D013656:Taurocholic Acid / Q000031:analogs & derivatives*; D055815:Young Adult
chemical_list: D001647:Bile Acids and Salts; D012644:Selenium Radioisotopes; D013656:Taurocholic Acid; C033638:23-seleno-25-homotaurocholic acid