Bile acid malabsorption in persistent diarrhoea

We have investigated bile acid malabsorption (BAM), and its response to tre atment, in patients seen in this district general hospital with chronic con tinuous or recurrent diarrhoea. Methods: Seven-day retention of 75-SeHCAT was measured (normal: >10%). Treatment: Patients were initially given conventional therapy (prednisolone +/- ASA drugs in Crohn's disease, and antidiarrhoeals in the others). If t his therapy failed, bile acid sequestrants (BAS) were prescribed. The defin ition of successful response was based on the patient's perception of susta ined improvement. Patients: The 304 patients were categorised as follows: Group 1: Crohn's di sease patients with ileal resection, in clinical remission (n=37). Group 2: Crohn's disease, unoperated and in clinical remission (n=44). Group 3: vag otomy and pyloroplasty, with/without cholecystectomy (n=26). Group 4: diarr hoea predominant 'irritable bowel syndrome' (IBS) (n=197). Results BAM was found in 97% (36/37), 54% (24/44) and 58% (15/26) of patien ts in groups 1, 2 and 3 respectively. One third (65/197) of patients with I BS had BAM. The outcome of treatment was available in 96 patients with BAM: of the patients with ileal resection 32% responded to antidiarrhoeals, 60% to BAS. Of the unoperated Crohn's patients 55% responded to disease-specif ic therapy, 40% to BAS. Of the gastric surgery patients 18% responded to co nventional treatment, 64% to BAS. Of the IBS patients 15% of responded to c onventional therapy, 70% to BAS. Conclusions: This observational study indicates that BAM is common in patie nts with chronic diarrhoea, and is frequently found in IBS. The results of open treatment suggest that, where antidiarrhoeal drugs fail in such patien ts, BAS are often effective.