Bile acid malabsorption: an under-investigated differential diagnosis in patients presenting with diarrhea predominant irritable bowel syndrome type symptoms

Scand J Gastroenterol. 2011 Jul;46(7-8):818-22. doi: 10.3109/00365521.2011.574728. Epub 2011 Apr 15.


Objective: Bile acid malabsorption (BAM) has been reported as a possible cause of diarrhea predominant irritable bowel syndrome (D-IBS) type symptoms. We aimed to determine how commonly patients with D-IBS type symptoms had a diagnosis of BAM as demonstrated by a positive SeHCAT (75 Selenium-homocholic acid taurine) test (retention <10% at seven days).

Materials and methods: A retrospective analysis was undertaken of patient's records for all patients who underwent a SeHCAT test between 2001 and 2009 in a tertiary hospital (Group A). Concurrently, a cohort of patients with Rome II D-IBS type symptoms was examined to determine the potential utility of SeHCAT test (Group B).

Results: In Group A 39.2% (n = 107/273) of patients had a positive SeHCAT result. The median time from first hospital visit to SeHCAT result was 30 weeks. Predictive factors for BAM: terminal ileal Crohn's disease (p < 0.01), terminal ileal resection (p < 0.01), and previous cholecystectomy (p < 0.01). 33.6% of patients who had a positive SeHCAT also had Rome II D-IBS. In Group B the D-IBS control cohort only 1.9% of patients had undergone a SeHCAT scan (p < 0.001 compared to Group A).

Conclusion: BAM is common and should be considered earlier when investigating unselected patients with D-IBS type symptoms.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Acids and Salts / metabolism*
  • Chi-Square Distribution
  • Cholecystectomy
  • Chronic Disease
  • Crohn Disease / complications
  • Diagnosis, Differential
  • Diarrhea / etiology*
  • Female
  • Humans
  • Ileal Diseases / complications
  • Ileal Diseases / surgery
  • Irritable Bowel Syndrome / complications
  • Irritable Bowel Syndrome / diagnosis
  • Logistic Models
  • Malabsorption Syndromes / complications*
  • Malabsorption Syndromes / diagnosis*
  • Malabsorption Syndromes / metabolism
  • Male
  • Middle Aged
  • Prospective Studies
  • Retrospective Studies
  • Selenium Radioisotopes
  • Taurocholic Acid / analogs & derivatives*
  • Young Adult


  • Bile Acids and Salts
  • Selenium Radioisotopes
  • Taurocholic Acid
  • 23-seleno-25-homotaurocholic acid