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High prevalence of idiopathic bile acid diarrhoea among patients with diarrhoea-predominant irritable bowel syndrome based on Rome III criteria

Aziz, I, Mumtaz S, Bholah H et al. Clin Gastroenterol Hepatol 2015;13:1650–1655.

Short summary

Nearly 25% of patients presenting with diarrhoea-predominant irritable bowel syndrome (IBS-D) have mild to moderate idiopathic bile acid diarrhea (BAD), according to this UK-based study. The severity of BAD in these patients was associated with impaired physical activity. 

This was a prospective dual-centre study involving adults who fulfilled the Rome III criteria for IBS-D. Patients with known risk factors for BAD were excluded from the study. The study included 118 individuals with a mean age of 41.7 years. The total prevalence of BAD was 23.7% (n=28) using a tauroselcholic (75selenium) acid SeHCAT retention score of less than 15% to define the presence of BAD. The prevalence was statistically similar across both study sites. 

Analysis of the results showed that individuals with BAD were significantly more likely to have a high body mass index (BMI) than individuals without BAD (31.6 kg/m2 vs 26.4 kg/m2, P=0.003). Patients with severe/moderate BAD had significant physical activity impairment when compared with patients with mild BAD (p=0.046).

The findings of this study question whether symptom-based criteria will positively diagnose IBS-D without the need to exclude possible underlying organic pathology, and clearly show that idiopathic BAD can masquerade as BAD. Future guidelines should therefore include diagnostic testing to exclude BAD before a diagnosis of IBS-D is made.

Job number: JB57410GBx Date of Preparation: June 2019

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