title: Outcomes from treating bile acid malabsorption using a multidisciplinary approach.
abstract: OBJECTIVE
  Despite bile acid malabsorption affecting >1 % of the population, the outcomes of treatment are largely unreported. This study evaluated the effectiveness of a structured intervention for this condition.
  
  
  METHODS
  This was a retrospective evaluation of prospectively recorded patient reported outcome measures in a consecutive cohort of patients diagnosed with bile acid malabsorption seen in a cancer centre gastroenterology clinic. Every patient completed a 7-day food diary, a gastrointestinal symptom rating scale questionnaire and Bristol stool chart before the first clinic appointment and the symptom questionnaire and Bristol stool chart before all subsequent appointments. Patients who reported any episodes of type 6 or 7 stool were referred for a (75)Selenium (Se) homocholic acid taurine scan. Abnormal gastrointestinal symptoms were investigated and treated systematically using a peer reviewed management algorithm.
  
  
  RESULTS
  Between 2011 and 2013, 136 men, 146 women, median age 66 years (range 19-89) underwent a scan. 143 (51 %) had 7-day isotope retention of ≤20 %. 105 (73 %) had previously undergone pelvic radiotherapy and 67 (47 %) GI surgery. 123 (86 %) were treated with low-fat diets, 79 (55 %) with a bile acid sequestrant, 73 (51 %) both. On discharge, 100 (70 %) patients reported an overall symptom improvement (mean -4.2 points, p < 0.0001). In patients who had only bile acid malabsorption and no other gastrointestinal diagnoses, 77 % (41/53) reported a mean improvement of -5.4 points (p < 0.0005). Patients reported a clinically significant improvement in urgency, faecal incontinence, wind, nocturnal defaecation, tiredness, abdominal pain, bloating, and steatorrhoea, (p = <0.0005). Stool frequency was reduced and stool consistency was improved.
  
  
  CONCLUSIONS
  In this large cohort of complex patients, bile acid malabsorption is common and a multidisciplinary approach to managing gastrointestinal symptoms is effective.
authors.affiliation: The GI Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.
authors.forename: Ankur
authors.initials: A
authors.lastname: Gupta
authors.forename: Ann C
authors.initials: AC
authors.lastname: Muls
authors.forename: Amyn
authors.initials: A
authors.lastname: Lalji
authors.forename: Karen
authors.initials: K
authors.lastname: Thomas
authors.forename: Lorraine
authors.initials: L
authors.lastname: Watson
authors.forename: Clare
authors.initials: C
authors.lastname: Shaw
authors.forename: H Jervoise N
authors.initials: HJ
authors.lastname: Andreyev
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001647:Bile Acids and Salts / Q000378:metabolism*; D003967:Diarrhea / Q000628:therapy*; D004041:Dietary Fats; D005260:Female; D005767:Gastrointestinal Diseases / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D045602:Steatorrhea / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D001647:Bile Acids and Salts; D004041:Dietary Fats