Systematic Review With Meta-Analysis: The Prevalence of Bile Acid Malabsorption in the Irritable Bowel Syndrome With Diarrhoea

Aliment Pharmacol Ther. 2015 Jul;42(1):3-11. doi: 10.1111/apt.13227. Epub 2015 Apr 27.

Abstract

Background: Irritable bowel syndrome is a widespread disorder with a marked socioeconomic burden. Previous studies support the proposal that a subset of patients with features compatible with diarrhoea-predominant IBS (IBS-D) have bile acid malabsorption (BAM).

Aim: To perform a systematic review and meta-analysis to assess the prevalence of BAM in patients meeting the accepted criteria for IBS-D.

Methods: MEDLINE and EMBASE were searched up to March 2015. Studies recruiting adults with IBS-D, defined by the Manning, Kruis, Rome I, II or III criteria and which used 23-seleno-25-homotaurocholic acid (SeHCAT) testing for the assessment of BAM were included. BAM was defined as 7 day SeHCAT retention of <10%. We calculated the rate of BAM and 95% confidence intervals (CI) using a random effects model. The methodological quality of included studies was evaluated using the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2).

Results: The search strategy identified six relevant studies comprising 908 individuals. The rate of BAM ranged from 16.9% to 35.3%. The pooled rate was 28.1% (95% CI: 22.6-34%). There was significant heterogeneity in effect sizes (Q-test χ(2) = 17.9, P < 0.004; I(2) = 72.1%). The type of diagnostic criteria used or study country did not significantly modify the effect.

Conclusions: These data provide evidence that in excess of one quarter of patients meeting accepted criteria for IBS-D have bile acid malabsorption. This distinction has implications for the interpretation of previous studies, as well as contemporaneous clinical practice and future guideline development.

Publication types

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

MeSH terms

  • Adult
  • Bile Acids and Salts / metabolism*
  • Diarrhea / epidemiology
  • Diarrhea / etiology
  • Humans
  • Irritable Bowel Syndrome / diagnosis
  • Irritable Bowel Syndrome / physiopathology*
  • Malabsorption Syndromes / diagnosis
  • Malabsorption Syndromes / epidemiology*
  • Malabsorption Syndromes / etiology
  • Prevalence

Substances

  • Bile Acids and Salts