Prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics: a prospective study
Abstract Background Bile acid malabsorption occurs in up to one third of patients with chronic diarrhoea of functional characteristics. The gold standard test for its diagnosis is the 75Selenium homocholic acid taurine (75SeHCAT) test. The aim of this work is to confirm previous data suggesting that...
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BMC
2021-02-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-021-01637-4 |
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| author | Virginia Flores Helena Martínez-Lozano Federico Bighelli Javier Orcajo Javier García-Lledó Juan Carlos Alonso-Farto Luis Menchén |
| author_facet | Virginia Flores Helena Martínez-Lozano Federico Bighelli Javier Orcajo Javier García-Lledó Juan Carlos Alonso-Farto Luis Menchén |
| author_sort | Virginia Flores |
| collection | DOAJ |
| description | Abstract Background Bile acid malabsorption occurs in up to one third of patients with chronic diarrhoea of functional characteristics. The gold standard test for its diagnosis is the 75Selenium homocholic acid taurine (75SeHCAT) test. The aim of this work is to confirm previous data suggesting that bile acid malabsorption, diagnosed by 75Se-HCAT test, is the underlying cause of diarrhoea in a significant proportion of patients previously diagnosed with a functional disorder. In addition, we have analysed the clinical response of bile acid sequestrants in those patients with a bile acid diarrhoea diagnosis. Methods This is a prospective, single-centre study including consecutive adult patients diagnosed with chronic diarrhoea of unknown origin and with functional characteristics; systematic rule out of common causes of chronic diarrhoea was performed before bile acid malabsorption evaluation by 75SeHCAT scanning. A retention percentage less than 10% was considered positive. Clinical response to cholestyramine was further evaluated in those patients with a positive diagnosis of bile acid diarrhoea Results 38 patients (20 male, mean age 37.5 years) were finally included. Twenty (52.6%) patients included had a positive 75SeHCAT test. Median body mass index was significantly higher in those patients. We did not find significant differences in other clinical or biochemical variables 75SeHCAT-positive and 75SeHCAT-negative groups. Only 6 of 17 (35.3%) patients responded to cholestyramine treatment; 10 patients did not have response or withdraw the drug due to adverse events. Logistic regression analysis showed that none of the included variables was a predictor of clinical response to cholestyramine. Conclusions Bile acid malabsorption occurs in a high proportion of patients suffering from chronic diarrhoea with functional characteristics. Systematic investigation of bile acid malabsorption should be included in the diagnostic algorithms of patients with chronic watery diarrhoea in the routine clinical practice. Absence of response to cholestyramine does not rule out bile acid diarrhoea. |
| first_indexed | 2024-12-22T21:41:08Z |
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| id | doaj.art-bc679743ce4f4d24bf3a4b0890000b85 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-22T21:41:08Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-bc679743ce4f4d24bf3a4b0890000b852022-12-21T18:11:37ZengBMCBMC Gastroenterology1471-230X2021-02-012111710.1186/s12876-021-01637-4Prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics: a prospective studyVirginia Flores0Helena Martínez-Lozano1Federico Bighelli2Javier Orcajo3Javier García-Lledó4Juan Carlos Alonso-Farto5Luis Menchén6Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón – Instituto de Investigación Sanitaria Gregorio MarañónServicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón – Instituto de Investigación Sanitaria Gregorio MarañónServicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón – Instituto de Investigación Sanitaria Gregorio MarañónServicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón – Instituto de Investigación Sanitaria Gregorio MarañónServicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón – Instituto de Investigación Sanitaria Gregorio MarañónServicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón – Instituto de Investigación Sanitaria Gregorio MarañónServicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón – Instituto de Investigación Sanitaria Gregorio MarañónAbstract Background Bile acid malabsorption occurs in up to one third of patients with chronic diarrhoea of functional characteristics. The gold standard test for its diagnosis is the 75Selenium homocholic acid taurine (75SeHCAT) test. The aim of this work is to confirm previous data suggesting that bile acid malabsorption, diagnosed by 75Se-HCAT test, is the underlying cause of diarrhoea in a significant proportion of patients previously diagnosed with a functional disorder. In addition, we have analysed the clinical response of bile acid sequestrants in those patients with a bile acid diarrhoea diagnosis. Methods This is a prospective, single-centre study including consecutive adult patients diagnosed with chronic diarrhoea of unknown origin and with functional characteristics; systematic rule out of common causes of chronic diarrhoea was performed before bile acid malabsorption evaluation by 75SeHCAT scanning. A retention percentage less than 10% was considered positive. Clinical response to cholestyramine was further evaluated in those patients with a positive diagnosis of bile acid diarrhoea Results 38 patients (20 male, mean age 37.5 years) were finally included. Twenty (52.6%) patients included had a positive 75SeHCAT test. Median body mass index was significantly higher in those patients. We did not find significant differences in other clinical or biochemical variables 75SeHCAT-positive and 75SeHCAT-negative groups. Only 6 of 17 (35.3%) patients responded to cholestyramine treatment; 10 patients did not have response or withdraw the drug due to adverse events. Logistic regression analysis showed that none of the included variables was a predictor of clinical response to cholestyramine. Conclusions Bile acid malabsorption occurs in a high proportion of patients suffering from chronic diarrhoea with functional characteristics. Systematic investigation of bile acid malabsorption should be included in the diagnostic algorithms of patients with chronic watery diarrhoea in the routine clinical practice. Absence of response to cholestyramine does not rule out bile acid diarrhoea.https://doi.org/10.1186/s12876-021-01637-4Bile acid diarrhoeaBile acid malabsorptionSeHCATFunctional diarrhoeaIrritable bowel syndromeCholestyramine |
| spellingShingle | Virginia Flores Helena Martínez-Lozano Federico Bighelli Javier Orcajo Javier García-Lledó Juan Carlos Alonso-Farto Luis Menchén Prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics: a prospective study BMC Gastroenterology Bile acid diarrhoea Bile acid malabsorption SeHCAT Functional diarrhoea Irritable bowel syndrome Cholestyramine |
| title | Prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics: a prospective study |
| title_full | Prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics: a prospective study |
| title_fullStr | Prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics: a prospective study |
| title_full_unstemmed | Prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics: a prospective study |
| title_short | Prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics: a prospective study |
| title_sort | prevalence of biliary acid malabsorption in patients with chronic diarrhoea of functional characteristics a prospective study |
| topic | Bile acid diarrhoea Bile acid malabsorption SeHCAT Functional diarrhoea Irritable bowel syndrome Cholestyramine |
| url | https://doi.org/10.1186/s12876-021-01637-4 |
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