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.

BIle acid malabsorption (BAM) in patients with functional chronic diarrhea: Response to cholestyramine

2000 ◽  
Vol 118 (4) ◽  
pp. A885 ◽  
Author(s):  
Fernando Femandez-Banares ◽  
Maria Esteve ◽  
Jorge C. Espinos ◽  
Montserrat Forne ◽  
Josep Martin-Comin ◽  
...  
Keyword(s):  
Bile Acid ◽  
Chronic Diarrhea ◽  
Bile Acid Malabsorption

scholarly journals Canadian Association of Gastroenterology Clinical Practice Guideline on the Management of Bile Acid Diarrhea

2019 ◽  
Vol 3 (1) ◽  
pp. e10-e27
Author(s):  
Daniel C Sadowski ◽  
Michael Camilleri ◽  
William D Chey ◽  
Grigorios I Leontiadis ◽  
John K Marshall ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Bile Acid ◽  
Crohn's Disease ◽  
Chronic Diarrhea ◽  
Initial Therapy ◽  
Bile Acid Metabolism ◽  
Assessment Development ◽  
Evaluation Approach ◽  
Canadian Association ◽  
Irritable Bowel

Abstract Background and Aims Chronic diarrhea affects about 5% of the population overall. Altered bile acid metabolism is a common but frequently undiagnosed cause. Methods We performed a systematic search of publication databases for studies of assessment and management of bile acid diarrhea (BAD). The certainty (quality) of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation approach. Patient population, intervention, comparator and outcome questions were developed through an iterative process and were voted on by a group of specialists. Results The certainty of evidence was generally rated as very low. Therefore, 16 of 17 recommendations are conditional. In patients with chronic diarrhea, consideration of risk factors (terminal ileal resection, cholecystectomy or abdominal radiotherapy), but not additional symptoms, was recommended for identification of patients with possible BAD. The group suggested testing using 75selenium homocholic acid taurine (where available) or 7α-hydroxy-4-cholesten-3-one, including patients with irritable bowel syndrome with diarrhea, functional diarrhea and Crohn’s disease without inflammation. Testing was suggested over empiric bile acid sequestrant therapy (BAST). Once remediable causes are managed, the group suggested cholestyramine as initial therapy, with alternate BAST when tolerability is an issue. The group suggested against BAST for patients with extensive ileal Crohn’s disease or resection and suggested alternative antidiarrheal agents if BAST is not tolerated. Maintenance BAST should be given at the lowest effective dose, with a trial of intermittent, on-demand administration, concurrent medication review and reinvestigation for patients whose symptoms persist despite BAST. Conclusions Based on a systematic review, BAD should be considered for patients with chronic diarrhea. For patients with positive results from tests for BAD, a trial of BAST, initially with cholestyramine, is suggested.

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 Bile acid malabsorption in patients with chronic diarrhea and Crohn�s disease

2018 ◽  
Vol 111 ◽  
Author(s):  
Luisa M.� Mena Bares ◽  
José M. Benítez Cantero ◽  
Eva Iglesias Flores ◽  
Beatriz Gros Alcalde ◽  
Estefanía Moreno Ortega ◽  
...  
Keyword(s):  
Bile Acid ◽  
Chronic Diarrhea ◽  
Bile Acid Malabsorption
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