title: Bile acid malabsorption investigated by selenium-75-homocholic acid taurine ((75)SeHCAT) scans: causes and treatment responses to cholestyramine in 298 patients with chronic watery diarrhoea.
abstract: BACKGROUND
  The liver produces and secretes bile acids into the small intestine. In the small intestine, most of the bile acids are absorbed in the distal ileum with portal vein transportation back to the liver and resecretion (enterohepatic recycling). Increased spillover of bile acids from the small intestine into the colon (bile acid malabsorption) may affect the secretion of colonic water and electrolytes and result in watery diarrhoea. The aim of this study was to investigate the frequency of bile acid malabsorption and treatment responses to cholestyramine with (75)SeHCAT scanning among patients suffering from chronic watery diarrhoea.
  
  
  METHODS
  This was a retrospective study that included all patients who received a (75)SeHCAT scan over a five-year period (2004-2009).
  
  
  RESULTS
  In total, 298 patients (198 females, 100 men) with a median age of 42 years (range 16-82 years) were investigated. Bile acid malabsorption ((75)SeHCAT retention<15% after seven days) was identified in 201 patients (68%, 95% confidence interval (CI): 62%-73%). Bile acid malabsorption due to ileal dysfunction (Type I) was found in 77 patients, idiopathic bile acid malabsorption (Type II) was found in 68 patients and 56 patients with other conditions had bile acid malabsorption (Type III). Of the 150 patients who were able to take cholestyramine continuously, 108 patients (71%, CI: 63%-78%) reported a positive effect on their bowel habits.
  
  
  CONCLUSIONS
  Bile acid malabsorption is a frequent problem in patients with chronic watery diarrhoea. Treatment with bile acid binders was effective regardless of type and severity.
authors.affiliation: Department of Medicine V, Aarhus University Hospital, DK-8000 Aarhus C, Denmark. marta.borghede@gmail.com
authors.forename: Märta K
authors.initials: MK
authors.lastname: Borghede
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Schlütter
authors.forename: Jørgen S
authors.initials: JS
authors.lastname: Agnholt
authors.forename: Lisbet A
authors.initials: LA
authors.lastname: Christensen
authors.forename: Lars C
authors.initials: LC
authors.lastname: Gormsen
authors.forename: Jens F
authors.initials: JF
authors.lastname: Dahlerup
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D001647:Bile Acids and Salts / Q000378:metabolism*; D002792:Cholestyramine Resin / Q000008:administration & dosage*; D002908:Chronic Disease; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery; D003967:Diarrhea / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism; D004573:Electrolytes / Q000378:metabolism; D005260:Female; D006801:Humans; D007082:Ileum / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012644:Selenium Radioisotopes; D013656:Taurocholic Acid / Q000031:analogs & derivatives*; D014867:Water / Q000378:metabolism; D055815:Young Adult
chemical_list: D000924:Anticholesteremic Agents; D001647:Bile Acids and Salts; D004573:Electrolytes; D012644:Selenium Radioisotopes; D014867:Water; D002792:Cholestyramine Resin; D013656:Taurocholic Acid; C033638:23-seleno-25-homotaurocholic acid