Abstract
Bile acid malabsorption (BAM) causing chronic diarrhea may be due to organic as well as functional disorders, and some of them were included under the general label of diarrheic-type irritable bowel syndrome (IBS-D). The 75-selenium homocholic acid taurine (SeHCAT) test is a nuclear medicine investigation considered to be the gold standard for the diagnosis of bile acid malabsorption (BAM). Many studies demonstrate that it could be effective in the clinical workout of chronic diarrhea due to different conditions. The SeHCAT test provides a quantitative assessment to estimate the severity of BAM and the possible response to therapy with bile acid sequestrants (BASs). However, there is no general agreement regarding its cutoff value and the test is not widely available. The aim of this review is to discuss the advantages and disadvantages of the SeHCAT test in clinical practice.
Highlights
Bile acid diarrhea (BAD) is caused by bile acid malabsorption (BAM)
Bile acid malabsorption (BAM) causing chronic diarrhea may be due to organic as well as functional disorders, and some of them were included under the general label of diarrheic-type irritable bowel syndrome (IBS-D)
BAM is often caused by a surgical resection or a structural impairment of the ileum (i.e., Crohn’s disease (CD)), but many studies [2] demonstrate the presence of BAM in patients with predominant irritable bowel syndrome diarrhea (IBS-D) or with functional diarrhea (FD)
Summary
Bile acid diarrhea (BAD) is caused by bile acid malabsorption (BAM). It is characterised by watery diarrhea (often postprandial), bloating, urge for defecation, and faecal incontinence at times. BAM is classified as follows [3]: type 1: ileal dysfunction/resection (Crohn’s disease); type 2: primary or idiopathic, characterised by watery diarrhea with (IBS) or without (FD) pain responding to bile acid sequestrant drugs (BASs); type 3: associated with other gastrointestinal disorders such as coeliac disease, small intestinal bacterial overgrowth (SIBO), and chronic pancreatitis; and type 4: due to an impaired FGF-19 feedback inhibition that causes excessive BA synthesis [4]. Obeticholic acid could be a promising drug for BAM: it is an agonist of the farnesoid X receptor (FXR), which increases fibroblastic growth factor 19 (FGF-19) synthesis and decreases bile acid (BA) synthesis by hepatocytes [3, 5]
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