Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome

Aliment Pharmacol Ther. 2009 Oct;30(7):707-17. doi: 10.1111/j.1365-2036.2009.04081.x. Epub 2009 Jun 30.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Anion Exchange Resins / therapeutic use*
  • Bile Acids and Salts / metabolism*
  • Cholestyramine Resin / therapeutic use*
  • Diarrhea / epidemiology
  • Diarrhea / etiology*
  • Dose-Response Relationship, Drug
  • Humans
  • Irritable Bowel Syndrome / complications
  • Irritable Bowel Syndrome / epidemiology
  • Irritable Bowel Syndrome / physiopathology*
  • Malabsorption Syndromes / complications*
  • Malabsorption Syndromes / drug therapy
  • Malabsorption Syndromes / epidemiology
  • Prevalence
  • Prospective Studies
  • Retrospective Studies
  • Severity of Illness Index


  • Anion Exchange Resins
  • Bile Acids and Salts
  • Cholestyramine Resin