Role of bile acids and bile acid binding agents in patients with collagenous colitis

Background--In a retrospective study bile acid malabsorption was observed i n patients with collagenous colitis. Aims--To study the occurrence of bile acid malabsorption and the effect of bile acid binders prospectively in patients with chronic diarrhoea and coll agenous colitis. Methods--Over 36 months all patients referred because of chronic diarrhoea completed a diagnostic programme, including gastroscopy with duodenal biops y, colonoscopy with biopsies, and the (75)Sehomocholic acid taurine ((75)Se HCAT) test for bile acid malabsorption. Treatment with a bile acid binder ( cholestyramine in 24, colestipol in three) was given, irrespective of the r esults of the (75)SeHCAT test. Results-Collagenous colitis was found in 28 patients (six men, 22 women), 2 7 of whom had persistent symptoms and completed the programme. Four patient s had had a previous cholecystectomy or a distal gastric resection. The (75 )SeHCAT test was abnormal in 12/27 (44%) of the collagenous colitis patient s with 75SeHCAT values 0.5-9.7%, and normal in 15 patients (56%). Bile acid binding treatment was followed by a rapid, marked, or complete improvement in 21/27 (78%) of the collagenous colitis patients. Rapid improvement occu rred in 11/12 (92%) of the patients with bile acid malabsorption compared w ith 10/15 (67%) of the patients with normal (75)SeHCAT tests. Conclusion--Bile acid malabsorption is common in patients with collagenous colitis and is probably an important pathophysiological factor. Because of a high response rate without serious side effects, bile acid binding treatm ent should be considered for collagenous colitis, particularly patients wit h bile acid malabsorption.