title: Long-term outcomes in patients diagnosed with bile-acid diarrhoea.
abstract: OBJECTIVE
  Bile-acid diarrhoea (BAD) is a recognized cause of chronic diarrhoea; however, its detection remains suboptimal. Currently, there is a paucity of follow-up studies evaluating BAD. This work evaluates the natural history of BAD by examining individuals diagnosed with BAD [7 days of Se-homocholic acid taurine (SeHCAT) retention<10%] and determining the use of and response to bile-acid sequestrants (BAS).
  
  
  METHODS
  Of the 515 patients, 40% (207/515) who underwent an SeHCAT test at Sheffield Teaching Hospitals (2001-2012) for chronic diarrhoea had BAD. Of the 207 (51%) patients, 107 were diagnosed between 2001 and 2009. In accordance with the guidelines, all of these patients were commenced on BAS. In March 2013, these individuals were reassessed either in the clinic or over the telephone as part of a local service evaluation project. Comparisons were made of both pretreatment and post-treatment variables using a Wilcoxon rank test.
  
  
  RESULTS
  Of the 107 patients, 54% (58/107) were followed up, with a median time since diagnosis of 6 years. Among them, 38% were still using BAS at follow-up, with 28% using alternative antidiarrhoeals. The median stool frequency decreased from seven stools per day to three (P=0.0008) in those using BAS. The 34% of patients not receiving treatment had no change in their daily bowel frequency. The main reason for discontinuing treatment was poor tolerability of the BAS (colestyramine/colestipol).
  
  
  CONCLUSIONS
  Our findings indicate that BAD is a chronic condition that best improves with BAS. Consideration should be given to therapeutic options that have a better tolerability profile.
authors.affiliation: aDepartment of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust bDepartment of Infection and Immunity, Academic Unit of Gastroenterology, Medical School, University of Sheffield, Sheffield, UK.
authors.forename: Simeng
authors.initials: S
authors.lastname: Lin
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Gleeson
authors.forename: Christopher
authors.initials: C
authors.lastname: Osborne
authors.forename: Louise
authors.initials: L
authors.lastname: Messham
authors.forename: Matthew
authors.initials: M
authors.lastname: Kurien
mesh_terms: D000837:Anion Exchange Resins / Q000627:therapeutic use; D000930:Antidiarrheals / Q000627:therapeutic use; D001647:Bile Acids and Salts / Q000378:metabolism*; D002792:Cholestyramine Resin / Q000627:therapeutic use; D003084:Colestipol / Q000627:therapeutic use; D003672:Defecation; D003938:Diagnostic Techniques, Digestive System; D003967:Diarrhea / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D057915:Drug Substitution; D004739:England; D006784:Hospitals, Teaching; D006801:Humans; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D064449:Sequestering Agents / Q000627:therapeutic use; D013656:Taurocholic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000837:Anion Exchange Resins; D000930:Antidiarrheals; D001647:Bile Acids and Salts; D064449:Sequestering Agents; D002792:Cholestyramine Resin; D013656:Taurocholic Acid; C033638:23-seleno-25-homotaurocholic acid; D003084:Colestipol