Comparison between SeHCAT test and clinical response to cholestyramine in patients with chronic diarrhea and high suspicion of bile acid malabsorption: A single-center prospective study.
SeHCAT test
bile acid diarrhea
cholestyramine
chronic diarrhea
Journal
Journal of digestive diseases
ISSN: 1751-2980
Titre abrégé: J Dig Dis
Pays: Australia
ID NLM: 101302699
Informations de publication
Date de publication:
May 2024
May 2024
Historique:
revised:
29
04
2024
received:
09
01
2024
accepted:
16
05
2024
medline:
8
7
2024
pubmed:
8
7
2024
entrez:
8
7
2024
Statut:
ppublish
Résumé
We aimed to evaluate the clinical response to cholestyramine in patients with functional chronic diarrhea and a high clinical suspicion of bile-acid diarrhea (BAD) investigated with 75-selenium homocholic acid taurine (SeHCAT) test. Adult patients attending our outpatient clinic between January and December 2021 for chronic diarrhea with suspicion of BAD were proposed SeHCAT testing and a therapeutic trial of cholestyramine 4-8 g daily. Clinical response to cholestyramine was evaluated at 1, 3, 6, and 12 months. Clinical and demographic data were analyzed according to SeHCAT test results. Among the 50 patients with chronic diarrhea and clinical suspicion of BAD, 13 (26.0%) refused either SeHCAT testing or cholestyramine therapy. Finally, 37 patients (31 females, age 44 ± 14 years) agreed to undergo SeHCAT and were started on cholestyramine (median follow-up 14 months [interquartile range 6-16 months]). Initial response to cholestyramine was similar in patients with positive and negative SeHCAT test results, but improved over time in those with a positive test result. Long-term response (100% vs 65.2%, P = 0.02) and necessity of maintenance therapy for symptom control were more common in those with positive SeHCAT test result (71.4% vs 26.1%, P = 0.02). However, response to cholestyramine was also frequent in patients with a negative test result. The SeHCAT test accurately identifies patients with BAD who benefit from long-term cholestyramine treatment. Nevertheless, cholestyramine may be also effective in patients with chronic diarrhea but negative SeHCAT test result.
Identifiants
pubmed: 38973129
doi: 10.1111/1751-2980.13289
doi:
Substances chimiques
Cholestyramine Resin
11041-12-6
Bile Acids and Salts
0
Taurocholic Acid
5E090O0G3Z
23-seleno-25-homotaurocholic acid
75018-70-1
Selenium Radioisotopes
0
Types de publication
Journal Article
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
279-284Informations de copyright
© 2024 The Author(s). Journal of Digestive Diseases published by Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.
Références
Arasaradnam RP, Brown S, Forbes A, et al. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut. 2018;67(8):1380‐1399.
Wilcox C, Turner J, Green J. Systematic review: the management of chronic diarrhoea due to bile acid malabsorption. Aliment Pharmacol Ther. 2014;39(9):923‐939.
Kurien M, Thurgar E, Davies A, Akehurst R, Andreyev J. Challenging current views on bile acid diarrhoea and malabsorption. Frontline Gastroenterol. 2018;9(2):92‐97.
Camilleri M, Vijayvargiya P. The role of bile acids in chronic diarrhea. Am J Gastroenterol. 2020;115(10):1596‐1603.
Money ME, Camilleri M. Review: management of postprandial diarrhea syndrome. Am J Med. 2012;125(6):538‐544.
Walters JRF, Tasleem AM, Omer OS, Brydon WG, Dew T, le Roux CW. A new mechanism for bile acid diarrhea: defective feedback inhibition of bile acid biosynthesis. Clin Gastroenterol Hepatol. 2009;7(11):1189‐1194.
Scarpello JH, Hodgson E, Howlett HC. Effect of metformin on bile salt circulation and intestinal motility in type 2 diabetes mellitus. Diabet Med. 1998;15(8):651‐656.
Shiha MG, Ashgar Z, Fraser EM, Kurien M, Aziz I. High prevalence of primary bile acid diarrhoea in patients with functional diarrhoea and irritable bowel syndrome‐diarrhoea, based on Rome III and Rome IV criteria. EClinicalMedicine. 2020;25:100465. doi:10.1016/j.eclinm.2020.100465
Slattery SA, Niaz O, Aziz Q, Ford AC, Farmer AD. Systematic review with meta‐analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea. Aliment Pharmacol Ther. 2015;42(1):3‐11.
Aziz I, Mumtaz S, Bholah H, Chowdhury FU, Sanders DS, Ford AC. High prevalence of idiopathic bile acid diarrhea among patients with diarrhea‐predominant irritable bowel syndrome based on Rome III criteria. Clin Gastroenterol Hepatol. 2015;13(9):1650‐1655.e2.
Fani B, Bertani L, Paglianiti I, et al. Pros and cons of the SeHCAT test in bile acid diarrhea: a more appropriate use of an old nuclear medicine technique. Gastroenterol Res Pract. 2018;2018:2097359. doi:10.1155/2018/2097359
Turner JM, Pattni SS, Appleby RN, Walters JR. A positive SeHCAT test results in fewer subsequent investigations in patients with chronic diarrhoea. Frontline Gastroenterol. 2017;8(4):279‐283.
Orekoya O, McLaughlin J, Leitao E, Johns W, Lal S, Paine P. Quantifying bile acid malabsorption helps predict response and tailor sequestrant therapy. Clin Med (Lond). 2015;15(3):252‐257.
Costa S, Gattoni S, Nicolardi ML, et al. Prevalence and clinical features of bile acid diarrhea in patients with chronic diarrhea. J Dig Dis. 2021;22(2):108‐112.
Hendy P, Florin T. Letter: therapeutic trial is more informative than SeHCAT to diagnose bile acid malabsorption. Aliment Pharmacol Ther. 2015;42(6):780.
Mearin F, Lacy BE, Chang L, et al. Bowel disorders. Gastroenterology. 2016;150(6):1393‐1407.e5.
Wedlake L, A'Hern R, Russell D, Thomas K, Walters JRF, Andreyev HJN. Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea‐predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2009;30(7):707‐717.
Bajor A, Törnblom H, Rudling M, Ung KA, Simrén M. Increased colonic bile acid exposure: a relevant factor for symptoms and treatment in IBS. Gut. 2015;64(1):84‐92.
Bampton PA, Dinning PG, Kennedy ML, Lubowski DZ, Cook IJ. The proximal colonic motor response to rectal mechanical and chemical stimulation. Am J Physiol Gastrointest Liver Physiol. 2002;282(3):G443‐G449.
Mekjian HS, Phillips SF, Hofmann AF. Colonic secretion of water and electrolytes induced by bile acids: perfusion studies in man. J Clin Invest. 1971;50(8):1569‐1577.
Rao AS, Wong BS, Camilleri M, et al. Chenodeoxycholate in females with irritable bowel syndrome‐constipation: a pharmacodynamic and pharmacogenetic analysis. Gastroenterology. 2010;139(5):1549‐1558.e1.
Baumgartner M, Lang M, Holley H, et al. Mucosal biofilms are an endoscopic feature of irritable bowel syndrome and ulcerative colitis. Gastroenterology. 2021;161(4):1245‐1256.e20.
Vasant DH, Paine PA, Black CJ, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021;70(7):1214‐1240.
Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021;116(1):17‐44.
Moayyedi P, Andrews CN, MacQueen G, et al. Canadian Association of Gastroenterology clinical practice guideline for the management of irritable bowel syndrome (IBS). J Can Assoc Gastroenterol. 2019;2(1):6‐29.
Barbara G, Cremon C, Bellini M, et al. Italian guidelines for the management of irritable bowel syndrome: Joint Consensus from the Italian Societies of: Gastroenterology and Endoscopy (SIGE), Neurogastroenterology and Motility (SINGEM), Hospital Gastroenterologists and Endoscopists (AIGO), Digestive Endoscopy (SIED), General Medicine (SIMG), Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) and Pediatrics (SIP). Dig Liver Dis. 2023;55(2):187‐207.
Lupianez‐Merly C, Dilmaghani S, Camilleri M. Recent developments in diagnosing bile acid diarrhea. Expert Rev Gastroenterol Hepatol. 2023;17(12):1185‐1195.
Borup C, Vinter‐Jensen L, Jørgensen SPG, et al. Prospective comparison of diagnostic tests for bile acid diarrhoea. Aliment Pharmacol Ther. 2024;59(1):39‐50.