Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea‐predominant irritable bowel syndrome
Open accessAbstract
Summary: Background Recurrent, watery diarrhoea affects one‐third of patients diagnosed with irritable bowel syndrome (‘IBS‐D’). Idiopathic bile acid malabsorption (‘I‐BAM’) may be the cause. Aim To determine the prevalence of I‐BAM in patients suffering from IBS‐D. Methods A systematic search was performed of publications reporting patients presenting with IBS‐D type symptoms, who were subsequently confirmed as having I‐BAM by SeHCAT scanning. Results Eighteen relevant studies, 15 prospective, comprising 1223 patients were identified. Five studies (429 patients) indicated that 10% (CI: 7–13) patients had severe bile acid malabsorption (SeHCAT 7 day retention <5% of baseline value). 17 studies (1073 patients) indicated that 32% (CI: 29–35) patients had moderate bile acid malabsorption (SeHCAT <10%). 7 studies (618 patients) indicated that 26% (CI: 23–30) patients had mild (SeHCAT <15%) bile acid malabsorption. Pooled data from 15 studies showed a dose‐response relationship according to severity of malabsorption to treatment with a bile acid binder: response to colestyramine occurred in 96% of patients with <5% retention, 80% at <10% retention and 70% at <15% retention. Conclusions Idiopathic adult‐onset bile acid malabsorption is not rare. International guidelines for the management of irritable bowel syndrome need to be revised so that clinicians become more aware of this possibility.
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Symptoms of BAD can mimic IBS-D, with between one-in-three and one-in-four patients with suspected IBS-D having an abnormal SeHCAT retention, and response rates to a bile acid sequestrant are higher at retentions of <10% or <5%.
“Symptoms of BAD can mimic IBS-D, with between one-in-three and one-in-four patients with suspected IBS-D having an abnormal SeHCAT retention, 133 134 and response rates to a bile acid sequestrant are higher at retentions of <10% or <5%.135”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [135]
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- Authors
- WEDLAKE, L., A’HERN, R., RUSSELL, D., THOMAS, K., WALTERS, J. R. F., & ANDREYEV, H. J. N.
- Affiliations
- Royal Marsden Hospital (GB)
- Institute of Cancer Research (GB)
- Imperial College London (GB)
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2009-09-03
- Volume
- 30
- Issue
- 7
- Pages
- 707-717
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2000891332
- Cited by
- 435
- References
- 31
- Citations by year
- 2026: 16 · 2025: 19 · 2024: 27 · 2023: 19 · 2022: 26 · 2021: 44 · 2020: 26 · 2019: 37 · 2018: 23 · 2017: 22 · 2016: 30 · 2015: 36 · 2014: 30 · 2013: 28 · 2012: 19
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Epidemiology › Microscopic Colitis
- Keywords
- diarrhea-predominant irritable bowel syndrome, bile acid retention, prevalence, cholestyramine, dose-response relationship
- MeSH terms
- Adult, Anion Exchange Resins, Bile Acids and Salts, Cholestyramine Resin, Diarrhea, Dose-Response Relationship, Drug, Humans, Malabsorption Syndromes, Prospective Studies, Retrospective Studies, Severity of Illness Index, Prevalence, Irritable Bowel Syndrome
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