title: Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy.
abstract: Although recognised as a cause of chronic diarrhoea for over forty years, diagnostic tests and treatments for bile acid malabsorption (BAM) remain controversial. Recent National Institute for Health and Care Excellence (NICE) guidelines highlighted the lack of evidence in the field, and called for further research. This retrospective study explores the BAM subtype and severity, the use and response to bile acid sequestrants (BAS) and the prevalence of abnormal colonic histology. 264 selenium-75-labelled homocholic acid conjugated taurine (SeHCAT)-tested patient records were reviewed and the severity and subtype of BAM, presence of colonic histopathology and response to BAS were recorded. 53% of patients tested had BAM, with type-2 BAM in 45% of patients with presumed irritable bowel syndrome. Colonic histological abnormalities were similar overall between patients with (29%) or without (23%) BAM (p = 0.46) and between BAM subtypes, with no significant presence of inflammatory changes. 63% of patients with BAM had a successful BAS response which showed a trend to decreased response with reduced severity. Colestyramine was unsuccessful in 44% (38/87) and 45% of these (17/38) were related to medication intolerance, despite a positive SeHCAT. 47% (7/15) of colestyramine failures had a successful colesevelam response. No patient reported colesevelam intolerance. Quantifying severity of BAM appears to be useful in predicting BAS response. Colesevelam was better tolerated than colestyramine and showed some efficacy in colestyramine failures. Colestyramine failure should not be used to exclude BAM. Colonic histology is of no relevance.
authors.affiliation: Royal Bolton Hospital, Bolton, UK fikki.orekoya@nhs.net.
authors.forename: Oluwafikunayo
authors.initials: O
authors.lastname: Orekoya
authors.affiliation: Royal Bolton Hospital, Bolton, UK, and Department of Gastroenterology, Salford Royal Foundation Trust, Salford, UK.
authors.forename: John
authors.initials: J
authors.lastname: McLaughlin
authors.affiliation: Department of Nuclear Medicine, Salford Royal Foundation Trust, Salford, UK.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Leitao
authors.affiliation: Department of Nuclear Medicine, Salford Royal Foundation Trust, Salford, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Johns
authors.affiliation: Department of Gastroenterology, Salford Royal Foundation Trust, Salford, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Lal
authors.affiliation: Department of Gastroenterology, Salford Royal Foundation Trust, Salford, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Paine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000499:Allylamine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001647:Bile Acids and Salts / Q000378:metabolism*; D002792:Cholestyramine Resin / Q000627:therapeutic use; D000069472:Colesevelam Hydrochloride; D003106:Colon / Q000473:pathology; D003967:Diarrhea / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D045602:Steatorrhea / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D013656:Taurocholic Acid / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D000924:Anticholesteremic Agents; D001647:Bile Acids and Salts; D002792:Cholestyramine Resin; D000499:Allylamine; D013656:Taurocholic Acid; C033638:23-seleno-25-homotaurocholic acid; D000069472:Colesevelam Hydrochloride
keywords: Diarrhoea; SeHCAT; bile acid malabsorption; bile acid sequestrant; colesevelam; colestyramine