Bile acid malabsorption as a cause of chronic diarrhea: diagnostic value of 7alpha-hydroxy-4-cholesten-3-one in serum

Dig Dis Sci. 1999 Jan;44(1):14-9. doi: 10.1023/a:1026681512303.


To evaluate the usefulness of 7a-hydroxy-4-cholesten-3-one (HCO) serum concentrations as a diagnostic marker of bile acid malabsorption, we determined the reference range of HCO in 106 normal subjects (age 40.2+/-16.8 years; 55 women, 51 men) and conducted a utility study in 23 patients with chronic diarrhea of unknown origin (age 49.4+/-15.3 years, 13 women, 10 men). The diagnosis of bile acid malabsorption was made on the basis of a decreased retention of [75Se]homocholyltaurine after oral application (75SeHCAT test). HCO (reference range: 6-48 ng/ml) and the 75SeHCAT test yielded the same results in 19/23 (83%) patients. Bile acid malabsorption was identified by an increase of HCO in serum with a sensitivity of 90% and a specificity of 79%. Analysis of HCO in serum may serve as a novel, simple, and sensitive method for the detection of bile acid malabsorption in patients with chronic diarrhea of unknown origin.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bile Acids and Salts / metabolism*
  • Biomarkers / blood*
  • Cholestenones / blood*
  • Chronic Disease
  • Diarrhea / etiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Sensitivity and Specificity
  • Taurocholic Acid / analogs & derivatives
  • Taurocholic Acid / metabolism


  • Bile Acids and Salts
  • Biomarkers
  • Cholestenones
  • 7 alpha-hydroxy-4-cholesten-3-one
  • Taurocholic Acid
  • 23-seleno-25-homotaurocholic acid