title: Multicentre prospective survey of SeHCAT provision and practice in the UK.
abstract: OBJECTIVE
  A clinical diagnosis of bile acid malabsorption (BAM) can be confirmed using SeHCAT (tauroselcholic ((75)selenium) acid), a radiolabelled synthetic bile acid. However, while BAM can be the cause of chronic diarrhoea, it is often overlooked as a potential diagnosis. Therefore, we investigated the use of SeHCAT for diagnosis of BAM in UK hospitals.
  
  
  METHODS
  A multicentre survey was conducted capturing centre and patient-level information detailing patient care-pathways, clinical history, SeHCAT results, treatment with bile acid sequestrants (BAS), and follow-up in clinics. Eligible data from 38 centres and 1036 patients were entered into a validated management system.
  
  
  RESULTS
  SeHCAT protocol varied between centres, with no standardised patient positioning, and differing referral systems. Surveyed patients had a mean age of 50 years and predominantly women (65%). The mean SeHCAT retention score for all patients was 19% (95% CI 17.8% to 20.3%). However, this differed with suspected BAM type: type 1: 9% (95% CI 6.3% to 11.4%), type 2: 21% (95% CI 19.2% to 23.0%) and type 3: 22% (95% CI 19.6% to 24.2%). Centre-defined 'abnormal' and 'borderline' results represented over 50% of the survey population. BAS treatment was prescribed to only 73% of patients with abnormal results.
  
  
  CONCLUSIONS
  The study identified a lack of consistent cut-off/threshold values, with differing centre criteria for defining an 'abnormal' SeHCAT result. BAS prescription was not related in a simple way to the SeHCAT result, nor to the centre-defined result, highlighting a lack of clear patient care-pathways. There is a clear need for a future diagnostic accuracy study and a better understanding of optimal management pathways.
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK; NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, London, UK.
authors.forename: Jennifer A
authors.identifier: 0000-0002-3156-0479
authors.initials: JA
authors.lastname: Summers
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK; NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, London, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Peacock
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK; NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, London, UK.
authors.forename: Bolaji
authors.initials: B
authors.lastname: Coker
authors.affiliation: King's Technology Evaluation Centre, King's College London, London, UK; Department of Medical Engineering and Physics, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Viktoria
authors.initials: V
authors.lastname: McMillan
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK; NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, London, UK.
authors.forename: Mercy
authors.initials: M
authors.lastname: Ofuya
authors.affiliation: King's Technology Evaluation Centre, King's College London, London, UK; Department of Medical Engineering and Physics, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Lewis
authors.affiliation: King's Technology Evaluation Centre, King's College London, London, UK; Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Keevil
authors.affiliation: Department of Gastroenterology , King's College Hospital NHS Foundation Trust , London , UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Logan
authors.affiliation: Faculty of Medical and Human Sciences, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK; Research Committee, British Society of Gastroenterology, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: McLaughlin
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK; NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, London, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Reid
keywords: BILE ACID; DIARRHOEA; IMAGING; IRRITABLE BOWEL SYNDROME; MALABSORPTION