Journal
NEUROGASTROENTEROLOGY AND MOTILITY
Volume 24, Issue 11, Pages -Publisher
WILEY-BLACKWELL
DOI: 10.1111/j.1365-2982.2012.01953.x
Keywords
bile acid malabsorption; diarrhea; irritable bowel syndrome; SeHCAT scan
Funding
- GE Healthcare
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Background Many physicians do not consider the diagnosis of bile acid malabsorption in patients with chronic diarrhea, or do not have access to testing. We examined yield of 23-seleno-25-homo-tauro-cholic acid (SeHCAT) scanning in chronic diarrhea patients, and attempted to identify predictors of a positive test. Methods Consecutive patients with chronic diarrhea undergoing SeHCAT scan over a 7-year period were identified retrospectively. Bile acid malabsorption was defined as present at a retention of <15%. Medical records were reviewed to obtain information regarding proposed risk factors. Gastrointestinal symptoms were recorded, and patients were classified as having diarrhea-predominant irritable bowel syndrome (IBS-D) if they reported abdominal pain or discomfort. Independent risk factors were assessed using multivariate logistic regression, and odds ratios (ORs) with 99% confidence intervals (CIs) were calculated. Key Results Of 373 patients, 190 (50.9%) had bile acid malabsorption. Previous cholecystectomy (OR 2.51; 99% CI 1.105.77), terminal ileal resection or right hemicolectomy for Crohns disease (OR 12.4; 99% CI 2.4263.8), and terminal ileal resection or right hemicolectomy for other reasons (OR 7.94; 99% CI 1.0261.6) were associated with its presence. Seventy-seven patients had IBS-D, and 21 (27.3%) tested positive. There were 168 patients with no risk factors for a positive SeHCAT scan, other than chronic diarrhea, and 63 (37.5%) had bile acid malabsorption. Conclusions & Inferences Bile acid malabsorption was present in 50% of patients undergoing SeHCAT scanning. Almost 40% of those without risk factors had evidence of bile acid malabsorption, and in those meeting criteria for IBS-D prevalence was almost 30%.
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