scholarly journals TP1.2.1SeHCAT scan as an investigation for chronic diarrhoea; a single trust experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Marwa Al-Azzawi ◽  
Sally Darnborough ◽  
Lynsey Devlin ◽  
Sai Han ◽  
Alison Bolster ◽  
...  
Keyword(s):  
Bile Acid ◽  
British Society ◽  
Symptom Improvement ◽  
Chronic Diarrhoea ◽  
Duration Of Symptoms ◽  
Bile Acid Sequestrants ◽  
Bile Acid Malabsorption ◽  
Included Patient ◽  
Patients At Risk ◽  
Type 3

Abstract Introduction:  Recent published (British Society of Gastroenterology) guidelines strongly recommended investigating unexplained chronic loose stools with  SeHCAT  scans when available rather than empirical treatment.  SeHCAT  scan was  introduced  at our trust in 2015. We aimed to audit this locally.   Methods  All  SeHCAT  scans that were done at our trust trust from Jan 2015 to March 2020  were included. Patient demographics along with risk factors and duration of symptoms were documented as well as the referred speciality.   Results   55 patients were identified. Average age at time of diagnosis was 50y (18-70y).  M:F  was 1:3.2 . Most scans were requested by the oncology team as part of the “pelvic radiotherapy late effects service” (n = 25), followed by the gastroenterology team (n = 22) and general surgery team (n = 8). The mean duration of symptoms was 4 years. 73% of the scans showed evidence of bile acid malabsorption (BAM)  (n = 40) with bile retention <15%, with the majority of them (n = 30) having severe BAM (retention <5%).  60% of the patients had at least one lower GI endoscopy as part of their workup. The majority of patients were found to have type 3 BAM (n = 37).   60% of patients had symptom improvement on either diet alone or with bile-acid sequestrants (n = 23) and were discharged. Conclusion:  SeHCAT scan is a useful test to investigate unexplained chronic diarrhoea. It is important to identify patients at risk of developing bile acid malabsorption. It is currently underutilized by our trust, which might be because of funding issues and awareness among clinicians.

scholarly journals Bile Acid Malabsorption in Chronic Diarrhea: Pathophysiology and Treatment

2013 ◽  
Vol 27 (11) ◽  
pp. 653-659 ◽  
Author(s):  
Alan Barkun ◽  
Jonathan Love ◽  
Michael Gould ◽  
Henryk Pluta ◽  
A Hillary Steinhart
Keyword(s):  
Bile Acid ◽  
High Performance ◽  
Chronic Diarrhea ◽  
Acid Synthesis ◽  
Bile Acid Synthesis ◽  
Bile Acid Malabsorption ◽  
Ileal Dysfunction ◽  
Type 3

BACKGROUND: Bile acid malabsorption (BAM) is a common but frequently under-recognized cause of chronic diarrhea, with an estimated prevalence of 4% to 5%.METHODS: The published literature for the period 1965 to 2012 was examined for articles regarding the pathophysiology and treatment of BAM to provide an overview of the management of BAM in gastroenterology practice.RESULTS: BAM is classified as type 1 (secondary to ileal dysfunction), type 2 (idiopathic) or type 3 (secondary to gastrointestinal disorders not associated with ileal dysfunction). The estimated prevalence of BAM is >90% in patients with resected Crohn disease (CD) and 11% to 52% of unresected CD patients (type 1); 33% in diarrhea-predominant irritable bowel syndrome (type 2); and is a frequent finding postcholecystectomy or postvagotomy (type 3). Investigations include BAM fecal bile acid assay, 23-seleno-25-homo-tauro-cholic acid (SeHCAT) testing and high-performance liquid chromatography of serum 7-α-OH-4-cholesten-3-one (C4), to determine the level of bile acid synthesis. A less time-consuming and expensive alternative in practice is an empirical trial of the bile acid sequestering agent cholestyramine. An estimated 70% to 96% of chronic diarrhea patients with BAM respond to short-course cholestyramine. Adverse effects include constipation, nausea, borborygmi, flatulence, bloating and abdominal pain. Other bile acid sequestering agents, such as colestipol and colesevelam, are currently being investigated for the treatment of BAM-associated diarrhea.CONCLUSIONS: BAM is a common cause of chronic diarrhea presenting in gastroenterology practice. In accordance with current guidelines, an empirical trial of a bile acid sequestering agent is warranted as part of the clinical workup to rule out BAM.

scholarly journals Letter: bile acid malabsorption - what is the prevalence in patients with chronic diarrhoea?

2014 ◽  
Vol 40 (2) ◽  
pp. 215-215 ◽  
Author(s):  
M. Kurien ◽  
S. Chaudhary ◽  
J. R. McConnell ◽  
J. S. Leeds ◽  
D. S. Sanders
Keyword(s):  
Bile Acid ◽  
Chronic Diarrhoea ◽  
Bile Acid Malabsorption

Impact of bile acid malabsorption on steatorrhoea and symptoms in patients with chronic diarrhoea

2000 ◽  
Vol 12 (5) ◽  
pp. 541-548 ◽  
Author(s):  
Kjell-Arne Ung ◽  
Anders F. Kilander ◽  
Anders Lindgren ◽  
Hasse Abrahamsson
Keyword(s):  
Bile Acid ◽  
Chronic Diarrhoea ◽  
Bile Acid Malabsorption

Bile Acid Malabsorption in Patients with Chronic Diarrhoea: Clinical Value of SeHCAT Test

2003 ◽  
Vol 38 (8) ◽  
pp. 826-830 ◽  
Author(s):  
Wildt S. ◽  
S. Nørby Rasmussen ◽  
J. Lysgård Madsen ◽  
Rumessen J. J.
Keyword(s):  
Bile Acid ◽  
Chronic Diarrhoea ◽  
Clinical Value ◽  
Bile Acid Malabsorption

scholarly journals Pros and Cons of the SeHCAT Test in Bile Acid Diarrhea: A More Appropriate Use of an Old Nuclear Medicine Technique

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Bernardo Fani ◽  
Lorenzo Bertani ◽  
Italia Paglianiti ◽  
Lorenzo Fantechi ◽  
Nicola De Bortoli ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Bile Acid ◽  
Chronic Diarrhea ◽  
Response To Therapy ◽  
Bile Acid Sequestrants ◽  
Bile Acid Malabsorption ◽  
Advantages And Disadvantages ◽  
Pros And Cons ◽  
Irritable Bowel ◽  
Nuclear Medicine Technique

Bile acid malabsorption (BAM) causing chronic diarrhea may be due to organic as well as functional disorders, and some of them were included under the general label of diarrheic-type irritable bowel syndrome (IBS-D). The 75-selenium homocholic acid taurine (SeHCAT) test is a nuclear medicine investigation considered to be the gold standard for the diagnosis of bile acid malabsorption (BAM). Many studies demonstrate that it could be effective in the clinical workout of chronic diarrhea due to different conditions. The SeHCAT test provides a quantitative assessment to estimate the severity of BAM and the possible response to therapy with bile acid sequestrants (BASs). However, there is no general agreement regarding its cutoff value and the test is not widely available. The aim of this review is to discuss the advantages and disadvantages of the SeHCAT test in clinical practice.

scholarly journals Biliary lipid composition in idiopathic bile acid malabsorption

Gut ◽  
1998 ◽  
Vol 43 (6) ◽  
pp. 812-816 ◽  
Author(s):  
M Fracchia ◽  
S Pellegrino ◽  
P Secreto ◽  
A Pera ◽  
G Galatola
Keyword(s):  
Bile Acid ◽  
Bile Acids ◽  
Lipid Composition ◽  
Chronic Diarrhoea ◽  
Biliary Lipid ◽  
Bile Acid Pool ◽  
Acid Pool ◽  
Bile Acid Malabsorption ◽  
Increased Risk ◽  
Biliary Lipid Composition

Background—Chronic diarrhoea is the clinical hallmark of patients presenting with idiopathic bile acid malabsorption. Its pathogenesis is unknown; colonic water secretion can be induced by dihydroxy bile acids, but it is not known whether enrichment of the bile acid pool with these bile acids occurs in such patients. Furthermore, bile acid malabsorption is known to affect biliary lipid composition, but no information is available for the idiopathic type.Aims—To verify: (a) whether diarrhoea in patients with idiopathic bile acid malabsorption is associated with enrichment of the bile acid pool with dihydroxy bile acids; and (b) whether supersaturation with cholesterol of duodenal bile occurs in such patients as a result of chronic bile acid depletion.Patients—Thirteen patients with idiopathic bile acid malabsorption diagnosed according to abnormal 75SeHCAT test and absence of other organic diseases, and 23 control subjects.Methods—Bile rich duodenal fluid was collected during intravenous ceruletide infusion in the fasting state. Biliary lipids were analysed by enzymatic assays and bile acids by high performance liquid chromatography.Results—Patients with idiopathic bile acid malabsorption had a cholesterol saturation index similar to controls. Bile acid composition showed only a decrease in percentage cholic acid (29 (2)% versus 36 (2)%; p<0.05); the dihydroxy:trihydroxy bile acid ratio was similar to controls.Conclusions—Patients with idiopathic bile acid malabsorption do not have an increased risk of forming cholesterol gallstones. The mechanism of diarrhoea does not seem to depend on an enrichment of the bile acid pool with dihydroxy bile acids.

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