Challenging current views on bile acid diarrhoea and malabsorption

Kurien M et al. Frontline Gastroenterology 2018;9:92–97.

Short summary

Guidance for the use of tauroselcholic (75selenium) acid (SeHCAT) for the investigation of diarrhoea due to bile acid malabsorption (BAM) in patients with diarrhoea-predominant irritable bowel syndrome (IBS-D) and or Crohn’s disease without ileal resection is outlined in diagnostics guidance 7 (DG7). A review of DG7 in 2012 by the National Institute for Health and Care Excellence (NICE) determined that SeHCAT should be recommended for research purposes only. This study describes relevant information made available since this review and investigates the economic consequences of misdiagnosis or inefficient treatment of bile acid diarrhoea (BAD) and BAM.

BAD/BAM affects approximately 1% of the UK population and is frequently misdiagnosed as IBS-D, not considering patients that may be affected by BAM/BAD resultant from secondary causes. Diagnosis of BAD/BAM is often not considered conclusive and as such is not treated effectively. SeHCAT is a specific diagnostic test, licensed for the investigation of BAD/BAM, which has shown high diagnostic value. While NICE recognised that SeHCAT testing was a valuable diagnostic test, they were unable to conclude whether this technique was cost-effective in the diagnostic setting for BAM/BAD.

The authors of this paper suggest that BAD/BAM could affect significantly more than 1% of the population. Furthermore, the NICE model may have inadequately evaluated the cost and quality of life impact that could accompany the use of SeHCAT in routine practice. 

Commenting on the placement of SeHCAT testing in the diagnostic pathway for chronic diarrhoea, the authors noted that there is now evidence to place this test higher than the current British Society of Gastroenterology (BSG) guidelines suggest. 

Concluding their review, the authors suggest that the use of SeHCAT to diagnose BAD/BAM would reduce costs, and improve patient care and quality of life through more effective treatment and reduction in the use of unnecessary healthcare resources. For the patient, obtaining a definitive BAD/BAM diagnosis may additionaly improve treatment compliance as they would be confident of a treatment benefit outweighing the poor palatability of the treatment.

Job number: JB01833UK Date of Preparation: May 2022

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bile acid diarrhoea malabsorption sehcat diarrhoea-predominant irritable bowel syndrome (ibs-d) british society of gastroenterology (bsg) reduce costs nice model dg7 tauroselcholic (75selenium) acid

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How common is bile acid diarrhoea (BAD)?
Professor David S. Sanders 

How common is bile acid diarrhoea (BAD)?
Professor David S. Sanders 

Professor Sanders argues that many patients presenting with irritable bowel syndrome (IBS) have underlying diseases. He explores a series of studies that suggest approximately 25% of patients presenting with IBS symptoms have BAD as the underlying cause. 

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