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Idiopathic bile acid diarrhea common among patients who meet criteria for IBS-D
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A recent study found nearly a quarter of patients who meet Rome III criteria for diarrhea-predominant irritable bowel syndrome have idiopathic bile acid diarrhea.
“There have been previous reports that some patients with presumed IBS actually have bile acid diarrhea and this is responsible for their symptoms, rather than IBS,” Alexander C. Ford, MBChB, MD, FRCP, from St. James University Hospital and University of Leeds in the United Kingdom, told Healio Gastroenterology. “However, few of the previous studies have used the accepted diagnostic criteria for IBS. We conducted a study using state-of-the-art methodology.”
Alexander C. Ford
From January 2013 to April 2014, Ford and colleagues performed a prospective dual-center study of 118 consecutive adult patients (mean age, 41.7 years; 72.9% women; 91.5% Caucasian) who met Rome III criteria for IBS-D.
Patients with risk factors for bile acid diarrhea were excluded. The remaining patients reported baseline questionnaire data and were tested for bile acid diarrhea with the 75selenium homocholic acid taurine retention test (75SeHCAT, GE Healthcare), “a relatively simple and highly sensitive method of testing” for bile acid diarrhea, “in which retention of radio-labeled bile acids of less than 10% to 15% after 7 days is abnormal.” This test is available in the UK, some European countries and Canada, but not the U.S.
Overall, 23.7% of patients had bile acid diarrhea, 28.6% of which were mild cases, 28.6% were moderate and 42.8% were severe. Prevalence was similar between study sites.
Patients with bile acid diarrhea had greater mean BMI (31.6) compared with patients who did not have bile acid diarrhea (26.4; P = .003), and physical activity scores reported in the Short Form-36 questionnaire were lower in patients with moderate (43.8 ± 49.6) or severe (41.7 ± 41.7) bile acid diarrhea, compared to those with mild cases (87.5 ± 26.7; P = .046).
There were no significant differences in age, sex, depression, patient health questionnaire-12 responses or total SF-36 scores between patients with and without bile acid diarrhea.
“One in five patients with suspected IBS may actually have bile acid diarrhea,” Ford said. “They may respond poorly to conventional IBS treatments and may be better served receiving bile acid sequestrants.”
These findings suggest “that future guidelines should advocate diagnostic testing to exclude [bile acid diarrhea] before a diagnosis of D-IBS is made,” Ford and colleagues wrote. – by Adam Leitenberger
Disclosures: Ford and another researcher report they have received grant support and speakers’ fees from GE Healthcare.
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