title: High Prevalence of Idiopathic Bile Acid Diarrhea Among Patients With Diarrhea-Predominant Irritable Bowel Syndrome Based on Rome III Criteria.
abstract: OBJECTIVE
  Some studies have found that patients with idiopathic bile acid diarrhea (BAD) present with symptoms of diarrhea-predominant irritable bowel syndrome (D-IBS). However, these studies either were retrospective, did not define D-IBS according to current criteria, or included patients with chronic functional diarrhea. We performed a prospective study of the prevalence of idiopathic BAD in consecutive patients fulfilling the Rome III criteria for D-IBS.
  
  
  METHODS
  We analyzed data from 118 consecutive adult patients who fulfilled the Rome III criteria for D-IBS (mean age, 41.7 y; 72.9% female), seen at 2 gastroenterology clinics in the United Kingdom. We excluded patients with risk factors for BAD (previous history of cholecystectomy, terminal ileal Crohn's disease, terminal ileal resection or right hemicolectomy, pelvic or abdominal radiotherapy, celiac disease, or microscopic colitis). Participants completed questionnaires at baseline (on demographics, hospital anxiety, somatization, and depression, as well as the patient health questionnaire-12 and the Short Form-36), and then received the (75)selenium homocholic acid taurine retention test. Retention of (75)selenium homocholic acid taurine 7 days after administration was used to identify patients with idiopathic BAD (mild BAD, 10%-14.9%; moderate BAD, 5.1%-9.9%; and severe BAD, ≤5%).
  
  
  RESULTS
  Twenty-eight patients were found to have BAD (23.7% of total), with similar percentages at each study site (25.3% and 20%; P = .54). Eight patients had mild BAD (28.6%), 8 patients had moderate BAD (28.6%), and 12 patients had severe BAD (42.8%). There was no statistical difference in age, sex, depression, patient health questionnaire-12 responses, or SF-36 scores between individuals with vs without BAD. However, patients with BAD had a higher mean body mass index than patients without BAD (31.6 vs 26.4; P = .003). Physical activity (based on the Short Form-36) was significantly lower in subjects with moderate (43.8) or severe BAD (41.7), compared with patients with mild BAD (87.5) (P = .046).
  
  
  CONCLUSIONS
  Almost 25% of patients presenting with D-IBS have idiopathic BAD; most cases are moderate to severe. Guidelines should advocate testing to exclude BAD before patients are diagnosed with D-IBS.
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
authors.forename: Imran
authors.initials: I
authors.lastname: Aziz
authors.affiliation: Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom.
authors.forename: Saqib
authors.initials: S
authors.lastname: Mumtaz
authors.affiliation: Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom.
authors.forename: Hassan
authors.initials: H
authors.lastname: Bholah
authors.affiliation: Nuclear Medicine Department, St James's University Hospital, Leeds, United Kingdom.
authors.forename: Fahmid U
authors.initials: FU
authors.lastname: Chowdhury
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
authors.affiliation: Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom. Electronic address: alexf12399@yahoo.com.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Ford
mesh_terms: D000328:Adult; D001647:Bile Acids and Salts / Q000378:metabolism*; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D006113:United Kingdom
chemical_list: D001647:Bile Acids and Salts
keywords: Bile Acid Reabsorption; HADS; PHQ-12; Synthesis