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Idiopathic bile acid malabsorption: qualitative and quantitative clinical features and response to cholestyramine
Author(s) -
Sinha L.,
Liston R.,
Testa H. J.,
Moriarty K. J.
Publication year - 1998
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.1998.00388.x
Subject(s) - cholestyramine , bile acid malabsorption , gastroenterology , medicine , malabsorption , bile acid , irritable bowel syndrome , diarrhea , feces , cholesterol , paleontology , biology
Background: Idiopathic bile acid malabsorption is a poorly recognized cause of chronic diarrhoea. The SeHCAT ( 75 Selenium HomotauroCholic Acid Test) can accurately diagnose this condition. Aim: To identify patients with idiopathic bile acid malabsorption, to describe their clinical features, both qualitatively and quantitatively, and to assess the response to cholestyramine. Method: Idiopathic bile acid malabsorption was considered in all patients complaining of chronic diarrhoea. They were included in the study if their SeHCATs were positive (< 15% retention) and secondary causes of bile acid malabsorption were excluded. The response to therapy with cholestyramine was assessed. Results: Nine patients were diagnosed with idiopathic bile acid malabsorption (median SeHCAT retention 8%, range 3–12.6). Their median daily faecal weight was 285 g (range 85–676) and median faecal fat output was 17 mmol/24 h (range 8.3–38.8). Six patients had an immediate response to cholestyramine. There was a marked reduction in stool frequency (median stool frequency pre‐treatment 5/day vs. 2/day post‐treatment, P = 0.03). Five patients had large volume diarrhoea (faecal weight > 200 g/day) and three had steatorrhoea. Conclusions: Idiopathic bile acid malabsorption, once suspected, especially by documenting true ‘large volume’ watery diarrhoea or steatorrhoea, is easily diagnosed and response to therapy is often very good. There is often a previous history of gastrointestinal infection and this condition should be considered in patients with chronic diarrhoea of undetermined origin, especially before they are labelled as having irritable bowel syndrome.