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A positive SeHCAT test results in fewer subsequent investigations in patients with chronic diarrhoea
  1. James M Turner1,
  2. Sanjeev S Pattni1,2,
  3. Richard N Appleby1,
  4. Julian RF Walters1
  1. 1 Division of Digestive Diseases, Imperial College London, Imperial College Healthcare, London, UK
  2. 2 Department of Gastroenterology, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to Professor Julian RF Walters, Division of Digestive Diseases, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK; julian.walters{at}imperial.ac.uk

Abstract

Chronic diarrhoea is a common condition, resulting from a number of different disorders. Bile acid diarrhoea, occurring in about a third of these patients, is often undiagnosed. We hypothesised that a positive diagnosis of bile acid diarrhoea would reduce the need for subsequent investigations for alternative diagnoses.

Methods Patients previously recruited to a study of chronic diarrhoea who had selenium homocholic acid taurine (SeHCAT) testing and subsequent follow-up at our institution were identified. In a retrospective analysis, the numbers of defined investigations undertaken from the first 3 months after SeHCAT in the following 5 years were compared.

Results 90 patients were identified with primary bile acid diarrhoea (SeHCAT retention <15%, n=36) or idiopathic diarrhoea (SeHCAT retention >15%, n=54). Follow-up had been performed on 29 and 39 subjects, respectively, with no differences in previous investigations or the last contact date. In the follow-up period, the proportions of these patients who had undergone endoscopic procedures (gastroscopy, colonoscopy and sigmoidoscopy) were the same. However, there was a higher proportion of patients in the SeHCAT-negative group who had other investigations, including imaging, physiological tests and blood tests (p=0.037). The use of cross-sectional imaging was significantly higher in this group (p=0.015) with greater proportions having CT (0.44 vs 0.10) and MRI (0.26 vs 0.07). Ultrasound use and the number of blood tests were higher in the SeHCAT-negative group whereas the SeHCAT-positive group attended more clinic appointments (p=0.013).

Conclusion A positive diagnosis of bile acid diarrhoea, made by a SeHCAT test, resulted in reduced use of diagnostic investigations over the subsequent 5 years.

  • chronic diarrhoea
  • diarrhoeal disease
  • health service research
  • imaging
  • nuclear medicine

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Footnotes

  • Contributors JRFW concept; SSP, RNA, JMT data collection; JMT data analysis; all authors, critical revision of the manuscript.

  • Funding This work was supported by a grant from GE Healthcare. SSP was funded by the Bardhan Research and Education Trust and RNA by Albireo and Intercept Pharmaceuticals.

  • Disclaimer JRFW has received research grant support and has been a consultant for Albireo, GE Healthcare, Intercept, Novartis, Prometheus, Pendopharm.

  • Competing interests JRFW has received research grant support and has been a consultant for Albireo, GE Healthcare, Intercept, Novartis, Prometheus, Pendopharm.

  • Ethics approval Research ethics committee of Hammersmith and Queen Charlotte’s and Chelsea Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it published Online First. The footnote to table 3 has been corrected.

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