75SeHCAT scan in bile acid malabsorption in chronic diarrhoea

Rev Esp Med Nucl Imagen Mol. 2017 Jan-Feb;36(1):37-47. doi: 10.1016/j.remn.2016.08.005. Epub 2016 Oct 17.
[Article in English, Spanish]

Abstract

Chronic diarrhoea is a common entity in daily clinical practice and it leads to a loss in these patients quality of life. It may be the main symptom of multiple ethiologies including bile acid malabsorption (BAM) which has a comparable prevalence to celiac disease. The BAM results from imbalances in the homeostasis of bile acids in the enterohepatic circulation. It can be a consequence of ileal disease or ileal dysfunction (BAM type i), it can be considered idiopathic or primary (BAM type ii) or associated with other gastrointestinal entities (BAM type iii). Among the different diagnostic methods available, 75SeHCAT study is the primary current method due to its sensitivity, specificity, safety and low cost. The main disadvantage is that it's not available in all countries, so other diagnostic methods have appeared, such as serum measurement of FGF19 and C4, however they are significantly more complex and costly. The first-line treatment of bile acid diarrhoea is bile acid sequestrant, such as cholestyramine, which can be difficult to administer due to its poor tolerability and gastrointestinal side effects. These are less prominent with newer agents such as colesevelam. In summary, the BAM is a common entity underdiagnosed and undertreated, so it is essential to establish a diagnosis algorithm of chronic diarrhoea in which the 75SeHCAT study would be first or second line in the differential diagnosis of these patients.

Keywords: (75)SeHCAT; Algoritmo diagnóstico; Bile acid malabsorption; Bile acid sequestrants; Chronic diarrhoea; Diagnostic algorithm; Diarrea crónica; Malabsorción de ácidos biliares; Quelantes de ácidos biliares.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Bile Acids and Salts / classification
  • Bile Acids and Salts / metabolism*
  • Biomarkers
  • Cholestyramine Resin / therapeutic use
  • Chronic Disease
  • Colesevelam Hydrochloride / therapeutic use
  • Colestipol / therapeutic use
  • Diarrhea / classification
  • Diarrhea / complications
  • Diarrhea / diagnostic imaging*
  • Diarrhea / drug therapy
  • Diarrhea / etiology
  • Enterohepatic Circulation
  • Fasting
  • Feces / chemistry
  • Fibroblast Growth Factors / blood
  • Humans
  • Ileum / diagnostic imaging*
  • Ileum / metabolism
  • Intestinal Absorption
  • Positron-Emission Tomography*
  • Selenium Radioisotopes / pharmacokinetics*
  • Sensitivity and Specificity
  • Steatorrhea / classification
  • Steatorrhea / complications
  • Steatorrhea / diagnostic imaging*
  • Steatorrhea / drug therapy
  • Taurocholic Acid / pharmacokinetics*
  • Whole Body Imaging

Substances

  • Bile Acids and Salts
  • Biomarkers
  • FGF19 protein, human
  • Selenium Radioisotopes
  • Selenium-75
  • Cholestyramine Resin
  • Taurocholic Acid
  • Fibroblast Growth Factors
  • Colestipol
  • Colesevelam Hydrochloride

Supplementary concepts

  • Bile Acid Malabsorption, Primary