Prevalence of, and predictors of, bile acid malabsorption in outpatients with chronic diarrhea

Neurogastroenterol Motil. 2012 Nov;24(11):983-e538. doi: 10.1111/j.1365-2982.2012.01953.x. Epub 2012 Jul 5.


Background: Many physicians do not consider the diagnosis of bile acid malabsorption in patients with chronic diarrhea, or do not have access to testing. We examined yield of 23-seleno-25-homo-tauro-cholic acid (SeHCAT) scanning in chronic diarrhea patients, and attempted to identify predictors of a positive test.

Methods: Consecutive patients with chronic diarrhea undergoing SeHCAT scan over a 7-year period were identified retrospectively. Bile acid malabsorption was defined as present at a retention of <15%. Medical records were reviewed to obtain information regarding proposed risk factors. Gastrointestinal symptoms were recorded, and patients were classified as having diarrhea-predominant irritable bowel syndrome (IBS-D) if they reported abdominal pain or discomfort. Independent risk factors were assessed using multivariate logistic regression, and odds ratios (ORs) with 99% confidence intervals (CIs) were calculated.

Key results: Of 373 patients, 190 (50.9%) had bile acid malabsorption. Previous cholecystectomy (OR 2.51; 99% CI 1.10-5.77), terminal ileal resection or right hemicolectomy for Crohn's disease (OR 12.4; 99% CI 2.42-63.8), and terminal ileal resection or right hemicolectomy for other reasons (OR 7.94; 99% CI 1.02-61.6) were associated with its presence. Seventy-seven patients had IBS-D, and 21 (27.3%) tested positive. There were 168 patients with no risk factors for a positive SeHCAT scan, other than chronic diarrhea, and 63 (37.5%) had bile acid malabsorption.

Conclusions & inferences: Bile acid malabsorption was present in 50% of patients undergoing SeHCAT scanning. Almost 40% of those without risk factors had evidence of bile acid malabsorption, and in those meeting criteria for IBS-D prevalence was almost 30%.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Acids and Salts / metabolism
  • Diarrhea / complications
  • Diarrhea / epidemiology
  • Diarrhea / etiology*
  • Female
  • Humans
  • Inflammatory Bowel Diseases / complications
  • Inflammatory Bowel Diseases / epidemiology
  • Male
  • Middle Aged
  • Outpatients
  • Prevalence
  • Risk Factors
  • Steatorrhea / complications*
  • Steatorrhea / epidemiology*
  • Young Adult


  • Bile Acids and Salts

Supplementary concepts

  • Bile Acid Malabsorption, Primary