title: Prevalence of, and predictors of, bile acid malabsorption in outpatients with chronic diarrhea.
abstract: BACKGROUND
  Many physicians do not consider the diagnosis of bile acid malabsorption in patients with chronic diarrhea, or do not have access to testing. We examined yield of 23-seleno-25-homo-tauro-cholic acid (SeHCAT) scanning in chronic diarrhea patients, and attempted to identify predictors of a positive test.
  
  
  METHODS
  Consecutive patients with chronic diarrhea undergoing SeHCAT scan over a 7-year period were identified retrospectively. Bile acid malabsorption was defined as present at a retention of <15%. Medical records were reviewed to obtain information regarding proposed risk factors. Gastrointestinal symptoms were recorded, and patients were classified as having diarrhea-predominant irritable bowel syndrome (IBS-D) if they reported abdominal pain or discomfort. Independent risk factors were assessed using multivariate logistic regression, and odds ratios (ORs) with 99% confidence intervals (CIs) were calculated.
  
  
  RESULTS
  Of 373 patients, 190 (50.9%) had bile acid malabsorption. Previous cholecystectomy (OR 2.51; 99% CI 1.10-5.77), terminal ileal resection or right hemicolectomy for Crohn's disease (OR 12.4; 99% CI 2.42-63.8), and terminal ileal resection or right hemicolectomy for other reasons (OR 7.94; 99% CI 1.02-61.6) were associated with its presence. Seventy-seven patients had IBS-D, and 21 (27.3%) tested positive. There were 168 patients with no risk factors for a positive SeHCAT scan, other than chronic diarrhea, and 63 (37.5%) had bile acid malabsorption.
  
  
  CONCLUSIONS
  Bile acid malabsorption was present in 50% of patients undergoing SeHCAT scanning. Almost 40% of those without risk factors had evidence of bile acid malabsorption, and in those meeting criteria for IBS-D prevalence was almost 30%.
authors: Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.
authors: D J
authors: DJ
authors: Gracie
authors: J S
authors: JS
authors: Kane
authors: S
authors: S
authors: Mumtaz
authors: A F
authors: AF
authors: Scarsbrook
authors: F U
authors: FU
authors: Chowdhury
authors: A C
authors: AC
authors: Ford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001647:Bile Acids and Salts / Q000378:metabolism; D003967:Diarrhea / Q000150:complications / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D015995:Prevalence; D012307:Risk Factors; D045602:Steatorrhea / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D001647:Bile Acids and Salts