Aziz, I, Mumtaz, S, Bholah, H et al. (3 more authors) (2015) High Prevalence of Idiopathic Bile Acid Diarrhea Among Patients With Diarrhea-predominant Irritable Bowel Syndrome Based on Rome III Criteria. Clinical Gastroenterology and Hepatology, 13 (9). 1650 - 1655. ISSN 1542-3565
Abstract
Background & Aims: Some studies have found that patients with idiopathic bile acid diarrhea (BAD) present with symptoms of diarrhea-predominant irritable bowel syndrome (D-IBS). However, these studies were either retrospective, did not define D-IBS according to current criteria, or included patients with chronic functional diarrhea. We performed a prospective study of the prevalence of idiopathic BAD in consecutive patients fulfilling the Rome III criteria for D-IBS. Methods: We analyzed data from 118 consecutive adult patients who fulfilled the Rome III criteria for D-IBS (mean age, 41.7 years; 72.9% female), seen at 2 gastroenterology clinics in the UK. We excluded patients with risk factors for BAD (previous history of cholecystectomy, terminal ileal Crohn's disease, terminal ileal resection or right hemicolectomy, pelvic or abdominal radiotherapy, celiac disease, or microscopic colitis). Participants completed questionnaires at baseline (on demographics, hospital anxiety, somatization, and depression, as well as the patient health questionnaire-12 and the short form-36 [SF-36]), and then received the (75)selenium homocholic acid taurine retention test. Retention of (75)selenium homocholic acid taurine 7 days after administration was used to identify patients with idiopathic BAD (mild BAD, 10%-14.9%; moderate BAD, 5.1%-9.9%; and severe BAD, ≤5%). Results: Twenty-eight were found to have BAD (23.7% of total), with similar percentages at each study site (25.3% and 20%; P=.54). Eight patients had mild BAD (28.6%), 8 had moderate BAD (28.6%), and 12 had severe BAD (42.8%). There was no statistical difference in age or sex, or depression, patient health questionnaire-12, or SF-36 scores, between individuals with vs without BAD. However, patients with BAD had a higher mean body mass index than those without BAD (31.6 vs. 26.4; P=.003). Physical activity (based on the SF-36) was significantly lower in subjects with moderate (43.8) or severe BAD (41.7), compared to patients with mild BAD (87.5) (P=.046). Conclusion: Almost 25% of patients presenting with D-IBS have idiopathic BAD; most cases are moderate to severe. Guidelines should advocate testing to exclude BAD before patients are diagnosed with D-IBS.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2015 by the AGA Institute. This is an author produced version of a paper accepted for publication in Clinical Gastroenterology and Hepatology. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | PHQ-12; HADS; bile acid reabsorption; synthesis |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > Institute of Molecular Medicine (LIMM) (Leeds) > Section of Molecular Gastroenterology (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 08 Jul 2015 14:45 |
Last Modified: | 11 Mar 2016 04:14 |
Published Version: | http://dx.doi.org/10.1016/j.cgh.2015.03.002 |
Status: | Published |
Publisher: | WB Saunders |
Identification Number: | 10.1016/j.cgh.2015.03.002 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:84901 |